https://clinfowiki.org/wiki/api.php?action=feedcontributions&user=Samsun&feedformat=atomClinfowiki - User contributions [en]2024-03-29T14:12:50ZUser contributionsMediaWiki 1.22.4https://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-12-01T17:31:30Z<p>Samsun: /* Background: */</p>
<hr />
<div>== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started deploying 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drive global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
== Conclusion: ==<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
== References: ==<br />
<br />
# “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
# “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
# D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
# “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by Sunil Samuel<br />
[[Category:BMI512-FALL-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/Main_PageMain Page2020-10-28T16:50:15Z<p>Samsun: /* Other Technologies */</p>
<hr />
<div>'''Welcome to the OHSU Clinfowiki'''<br />
<br />
The OHSU Clinical Informatics Wiki (aka ClinfoWiki) is the implementation of a [http://en.wikipedia.org/wiki/Wiki wiki] website devoted to topics in [[Biomedical Informatics]]. <br />
<br />
The Department of Medical Informatics & Clinical Epidemiology (DMICE) is one of 27 academic departments in the School of Medicine at Oregon Health & Science University (OHSU). The mission of DMICE is to provide leadership, discovery and dissemination of knowledge in clinical informatics, clinical epidemiology, and bioinformatics / computation biology. This mission is fulfilled through programs of research, education, and service. DMICE programs are recognized internationally for their accomplishment and innovation. The OHSU Biomedical Informatics program is one of the largest of its kind in the world. <br />
<br />
Clinfowiki is edited by [https://www.ohsu.edu/people/vishnu-mohan/2BD88C7AE00A4A21861DFB0964974984 Vishnu Mohan, M.D., M.B.I.], and was created in 2005 by [https://en.wikipedia.org/wiki/Dean_F._Sittig Dean F. Sittig, Ph.D.].<br />
<br />
The site can be browsed by anyone. To begin a new article, or edit an existing article, you must first create an account and login to the ClinfoWiki. The easiest way to create a new page is to edit an existing page where you want your article to link from, and then place your page's name within double square brackets, like so: <nowiki> [[Your page name here]] </nowiki> If you then save the page and click on that link, you will be taken to a screen with a box where you can begin to write your content.<br />
<br />
[[Special:ActiveUsers|We]] are currently working on [[Special:Statistics|{{NUMBEROFARTICLES}}]] articles, and we '''[[Clinfowiki To Do|need your help]]''' to complete this study of Informatics. See [[Special:Statistics]] for more complete information on the site.<br />
<br />
The Clinfowiki has recently been reorganized into the <u>20</u> categories below. When adding (or editing) content, please try to ensure the content traces back to one of these categories.<br />
<br />
<br />
=[[:Category:Technologies | Technologies]]=<br />
<br />
==[[:Category: EHR | Electronic Medical Record (EMR)]]==<br />
* [[EHR | What is the Electronic Medical Record]]<br />
* [[EMR v. EHR]]<br />
* [[Interface Design of the EHR]]<br />
* [[EHR-enabled Research]]<br />
* [[Security of the distributed electronic patient record: a case-based approach to identifying policy issues]]<br />
* [[Purpose of EMRs]]<br />
* [[Registries]]<br />
<br />
==[[:Category: CPOE | Computerized Physician Order Entry (CPOE)]]==<br />
* [[CPOE | Computerized Physician Order Entry]]<br />
* [[Barcode medication administration]]<br />
* [[E-prescribing | Electronic Prescribing (E-prescribing)]]<br />
* [[Medication Errors]]<br />
<br />
==[[:Category: CDS | Clinical Decision Support (CDS)]]==<br />
* [[CDS | Clinical Decision Support]]<br />
* [[Timeline of the Development of Clinical Decision Support]]<br />
* [[The Evolution of Clinical Decision Support]]<br />
* [[Decision Support Service]]<br />
* [[Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department]]<br />
* [[Automated Clinical Decision Support (CDS) using Pattern Recognition/Temporal Relationships]]<br />
<br />
==[[:Category: PHR | Personal Health Record (PHR)]]==<br />
* [[PHR | Personal Health Records]]<br />
* [[PHA | Personal Health Applications]]<br />
<br />
==[[:Category: Reviews | Reviews of scientific papers]]==<br />
<br />
==[[:Category:Integrated Data Repositories (IDR) | Integrated Data Repositories (IDR)]]==<br />
* [[CIDR | Clinical Integrated Data Repositories (CIDR)]]<br />
<br />
==[[:Category:Ancillary Systems | Ancillary Systems]]==<br />
* [[Ancillary Clinical Information Systems]]<br />
* [[BioBanking | Biobanking -- a.k.a. Biorepositories or Tissue Bank]]<br />
* [[Anesthesia Information Management Systems (AIMS)]]<br />
<br />
==[[:Category:Medical Devices | Medical Devices]]==<br />
<DynamicPageList><br />
category = Medical Devices<br />
</DynamicPageList><br />
* [[mHealth]]<br />
<br />
==[[:Information Retrieval]]==<br />
* [[Semantic MEDLINE]]<br />
<br />
==[[:Category:Other Technologies | Other Technologies]]==<br />
* [[:Category:New_Technology| New CIS-related Technologies]]<br />
* [[FOSSM | Free and Open Source Software (FOSS) licensing in medicine]]<br />
* [[Unintended Consequences of HIT]]<br />
* [[i2b2 Informatics for Integrating Biology and the Bedside]]<br />
* [[The Cloud and it's impact on Health IT]]<br />
* [[Teleconcussion - An Emerging Sports Concussion Management Model]]<br />
* [[The Blockchain in Healthcare]]<br />
* [[American College of Emergency Physicians: InnovatED]]<br />
* [[Software-Guided insulin therapy]]<br />
* [[L1000 assay and the Connectivity Map dataset]]<br />
* [[5G and Healthcare]]<br />
<br />
=[[:Category:Applications | Applications]]=<br />
<br />
==[[:Category:Evidence Based Medicine (EBM) | Evidence Based Medicine (EBM)]]==<br />
* [[EBM | Evidence Based Medicine]]<br />
* [[Hierarchy of Evidence]]<br />
* Rationale, design,and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care<br />
* [[Efficacy of an Evidence-Based Clinical Decision Support in Primary Care Practices A Randomized Clinical Trial]]<br />
<br />
==[[:Category:Methodologies and Frameworks | Methodologies and Frameworks]]==<br />
* [[Evaluation and Design Methodologies]]<br />
* [[The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation]]<br />
* [[Sociotechnical systems]]<br />
* [[Data Center Planning and Design Overview for Healthcare Organizations]]<br />
* [[EHR Participatory Deployment Vs Black box Deployment methods]]<br />
* [[Real-time automatic polyp detection system for colonoscopy using artificial intelligence]]<br />
<br />
==[[:Category:Government, Public and Private Initiatives | Government, Public and Private Initiatives]]==<br />
* [[HITREC | Health Information Technology Regional Extension Centers (HITREC)]]<br />
* [[RHIO | Regional Health Information Organization (RHIO)]]<br />
* [[NHIN | Nationwide Health Information Network (NwHIN)]]<br />
* [[Assistant Secretary for Planning & Evaluation]] <br />
* [[Office of the National Coordinator for Health Information Technology (ONC)]] <br />
* [[Trusted Exchange Framework and Common Agreement (TEFCA)]] <br />
* [[Council on the Application of Health Information Technology (CAHIT)]] <br />
* [[Agency for Healthcare Research and Quality (AHRQ)]] <br />
* [[Centers for Medicare and Medicaid Services (CMS)]] <br />
* [[U.S. Food and Drug Administration (FDA)]] <br />
* [[National Institutes of Health (NIH)]] <br />
* [[Big Data to Knowledge (BD2K)]]<br />
* [[Indian Health Service (IHS)]] <br />
* [[Health Services and Resource Administration (HRSA)]] <br />
* [[Centers for Disease Control and Prevention (CDC)]] <br />
* [[U.S. Department of Commerce]] <br />
* [[Combined U.S. Department of Defense / Veterans Affairs Initiatives]] <br />
* [[U.S. Department of Defense (DoD) Initiatives]] <br />
* [[Department of Veterans Affairs Initiatives]] <br />
* [[U.S. Department of Homeland Security]] <br />
* [[Healthcare Information Technology Standards Panel (HITSP)]] <br />
* [[Purpose and overview | International perspectives]] <br />
* [[UK]] <br />
* [[National Electronic Health Record Program in United Kingdom]]<br />
* [[:Category:Blogposium|All articles resulting from the Blogposium collaboration]]<br />
* [[Maternal and Perinatal Quality Care Collaboratives]]<br />
* [[EHealth Initiative]]<br />
* [[Meaningful use]]<br />
* [[Electronic Laboratory Reporting]]<br />
* [[Department of Education]]<br />
* [[PMI | Precision Medicine Initiative (PMI)]]<br />
* [[Health Information and Management Systems Society (HIMSS)]]<br />
* [[Society for Participatory Medicine]]<br />
* [[Veteran’s Affairs Switch from VistA based Electronic Health Record to Cerner Millennium]]<br />
* [[Singapore NEHR]]<br />
* [[ORCATECH | Oregon Center for Aging and Technology (ORCATECH)]]<br />
<br />
==[[:Category:Training and User Support | Training and User Support]]==<br />
* [[Learning Health Systems (LHS)]]<br />
<br />
==[[:Category:Terminology and Coding | Terminology and Coding]]==<br />
* [[Glossary of acronyms]] <br />
* [[Definition and Use of Interface Terminologies]] <br />
* [[Common Terminology Services | Common Terminology Services (CTS)]]<br />
* [[Distributed Cognition and Knowledge-based Controlled Medical Terminologies]]<br />
* [[Ontology]] <br />
* [[International Statistical Classification of Diseases | International Statistical Classification of Diseases (ICD)]]<br />
* [[Systematized Nomenclature Of Medicine | Systematized Nomenclature Of Medicine (SNOMED)]] <br />
* [[International Dietetics and Nutrition Terminology | International Dietetics and Nutrition Terminology (IDNT)]]<br />
* [[International Classification of Primary Care | International Classification of Primary Care (ICPC)]]<br />
* [[Unified Medical Language System | Unified Medical Language System (UMLS)]]<br />
* [[Aggregated data]]<br />
<br />
==[[:Category:Workflow | Workflow]]==<br />
* [[Methods to capture workflow]] <br />
* [[Measurement]] <br />
* [[Importance of Workflow Analysis During Physician Office EMR Implementation]] <br />
* [[Workflow Management System]] <br />
* [[Process Mining]]<br />
* [[Using Evidence-Based Layout Design to Enhance Workflow in the Clinical Laboratory]]<br />
* [[Planning for Radiology CDS Technology]]<br />
<br />
==[[:Category:Interface, Usability and Accessibility | Interface, Usability and Accessibility]]==<br />
* [[Usability]] <br />
* [[Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA]]<br />
* [[Software Test Documentation]]<br />
* [[Data Model to Enhance the Security and Privacy of Healthcare Data]]<br />
<br />
==[[:Category:Data Visualization | Data Visualization]]==<br />
* [[Clinically Relevant Data Visualization]]<br />
<br />
=[[:Category:Reference | Reference]]=<br />
<br />
==[[:Category:Academics and Education | Academics and Education]]==<br />
* [[Informatics Students' Contributions|Contributions from OHSU students]]<br />
* [[List of Informatics Departments]]<br />
* [[Endowed Professorships | Endowed Professorships and Chairs in Health / Medical / Nursing / Biomedical Informatics]]<br />
* [[Graduate Medical Education Milestones]]<br />
* [[List of Clinical Informatics Conferences]]<br />
<br />
==[[:Category:Specialties and Disciplines | Specialties and Disciplines]]==<br />
* [[Bioinformatics]]<br />
* [[Chief Nursing Informatics Officer]]<br />
* [[Clinical Informatics Fellowship]]<br />
* [[Clinical research informatics]]<br />
* [[Clinical Social Work Informatics]]<br />
* [[Cognitive Informatics]]<br />
* [[Consumer health informatics]]<br />
* [[Dental informatics]]<br />
* [[Health informatics]]<br />
* [[Imaging informatics]]<br />
* [[Medical laboratory informatics]]<br />
* [[Medical Subspecialty Board of Clinical Informatics]]<br />
* [[Mental health informatics]]<br />
* [[Neuroinformatics]]<br />
* [[Nursing informatics]]<br />
* [[Pediatric Informatics]]<br />
* [[Pharmacy Informatics]]<br />
* [[Public Health Informatics]]<br />
* [[Quality Informatics]]<br />
* [[Traditional Chinese Medicine (TCM) informatics]]<br />
* [[Translational Bioinformatics]]<br />
* [[Ethics in Informatics]]<br />
<br />
==[[:Category:Research Groups | Research Groups]]==<br />
* [[CIRCLE: Clinical Informatics Research Collaborative]]<br />
* [[Biomedical Informatics Research Network (BIRN)]]<br />
<br />
==[[:Category:Literature | Literature]]==<br />
* [[Books | Books on Topics in Clinical Informatics]]<br />
* [[Leading Health Informatics and Medical Informatics Journals]]<br />
<br />
==[[:Category:External Links | External Links]]==<br />
* [http://www.ohsu.edu/xd/ Oregon Health & Science University]<br />
* [http://www.ohsu.edu/xd/education/schools/school-of-medicine/departments/clinical-departments/dmice/ The Department of Medical Informatics and Clinical Epidemiology at OHSU]<br />
* [http://www.cpoe.org Website of the Provider Order Entry Team from Oregon Health]<br />
* [http://hittransition.com/tools.htm Links to online tools for HIT/RHIO development]<br />
* [http://www.hitdashboard.com/unitedStates.aspx Health Information Technology Dashboard]<br />
* [http://wellness.wikispaces.com/Tactic+-+Use+Evolving+Health+Information+Technology+Tools Wellness Wiki: Use Evolving Health Information Technology Tools]<br />
* [http://www.emedicine.com/ eMedicine] Physician contributed medical articles and CME<br />
* [http://www.kmle.com KMLE Medical Dictionary] Medical dictionary and medical related links<br />
* [http://www.merckmedicus.com Merck Medicus] Contains a significant number of textbook resources (requires free registration<br />
* [http://www.nlm.nih.gov NLM] (US National Library of Medicine)<br />
* [http://www.webmd.com WebMD] General comprehensive online health information<br />
* [http://www.open.medicdrive.org Medicine 2.0] Comprehensive online Personal health record information.<br />
* [http://www.searchmedica.com SearchMedica.com] Searches medical literature for health care professionals<br />
* [http://www.ahima.org AHIMA] American Health Information Management Association<br />
* [http://www.amia.org AMIA] American Medical Informatics Association<br />
* [http://www.ania-caring.org ANIA-CARING] American Nursing Informatics Association and the Capital Area Roundtable on Informatics in NursinG<br />
* [http://www.himss.org HIMSS] Healthcare Information and Management Systems<br />
* [http://www.imia-medinfo.org IMIA] International Medical Informatics Association<br />
* [http://wellness.wikispaces.com/Tactic+-+Use+Evolving+Health+Information+Technology+Tools Use Evolving Health Information Technology Tools]<br />
* [http://wellness.wikispaces.com/Blueprint+for+an+Integrated+HIT+system+-+The+Patient+Life-Cycle+Wellness+System Blueprint for an Integrated HIT system - The Patient Life-Cycle Wellness System]<br />
* [http://circleinformatics.org CIRCLE: Clinical Informatics Research Collaborative]</div>Samsunhttps://clinfowiki.org/wiki/index.php/Category:Other_TechnologiesCategory:Other Technologies2020-10-28T16:46:48Z<p>Samsun: </p>
<hr />
<div>This is a core category for Clinfowiki. It belongs to Clinfowiki > Technologies.<br />
<br />
[[Category:Technologies]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/Category:Other_TechnologiesCategory:Other Technologies2020-10-28T16:45:35Z<p>Samsun: </p>
<hr />
<div>This is a core category for Clinfowiki. It belongs to Clinfowiki > Technologies.<br />
<br />
[[Category:Technologies]]<br />
<br />
[[5G and Healthcare]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-10-28T16:18:20Z<p>Samsun: </p>
<hr />
<div>== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment of 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drove global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
== Conclusion: ==<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
== References: ==<br />
<br />
# “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
# “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
# D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
# “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by Sunil Samuel<br />
[[Category:BMI512-SPRING-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-10-28T16:17:46Z<p>Samsun: </p>
<hr />
<div>[[Other Technologies]]<br />
== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment of 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drove global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
== Conclusion: ==<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
== References: ==<br />
<br />
# “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
# “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
# D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
# “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by Sunil Samuel<br />
[[Category:BMI512-SPRING-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-10-28T15:48:51Z<p>Samsun: /* References: */</p>
<hr />
<div><br />
== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment of 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drove global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
== Conclusion: ==<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
== References: ==<br />
<br />
# “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
# “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
# D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
# “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by Sunil Samuel<br />
[[Category:BMI512-SPRING-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/RansomwareRansomware2020-10-27T23:01:07Z<p>Samsun: </p>
<hr />
<div>'''Ransomware''' is a type of [[malware|malware]] (malicious software) that limits users from accessing all or part of their computer unless a ransom is paid, often in the form of cryptocurrency such as Bitcoin.<br />
Some forms of ransomware lock a computer’s screen and display a demand for payment. [1] The victim’s files remain untouched, however, and this form of ransomware can sometimes be removed without paying the attacker. [2] Newer ransomware called ''cryptoviral extortion'' encrypts a user’s files. This more advanced form of malware renders files inaccessible even if the malware is removed. [3] Thus, the victim must pay the attacker for the decryption key in order to regain access to his files. <br />
<br />
== History of encrypting ransomware ==<br />
In 1989, Joseph Popp created the first known encrypting malware called the “AIDS Trojan” which was distributed on floppy disks via snail mail. This malware was limited in its design. The AIDS Trojan only encrypted the names of files and not the files themselves. Furthermore, the trojan used symmetric encryption (where the same key is used to encrypt and decrypt files) and the decryption key could be extracted from the code of the trojan. This made it unnecessary to pay ransom to reverse the effects of the trojan. [4]<br />
<br />
The idea of using asymmetric or public key [[encryption|encryption]] was introduced by researchers Adam L. Young and Moti Yung 1996 at an IEEE symposium. [5] Actual ransomware using this scheme became increasingly common after 2005. [6] In asymmetric encryption, a different key is used for encryption (the public key) and for decryption (the private key). The public key is used to encrypt the victim’s files while the private key is known only to the creators of the ransomware. The ransomware’s effects cannot be overcome without paying for the private key. [5]<br />
<br />
== Mechanism of encryption ==<br />
More recent malware such as CryptoLocker and WannaCry use a hybrid model combining asymmetric and symmetric encryption to capitalize on the strengths of both schemes. Using asymmetric keys allows the attackers to keep the private key secret. Symmetric keys allow encryption to occur more efficiently, enabling victim files to rapidly be encrypted. [7] <br />
# The attacker creates a key pair. The public key is placed in the code of the malware. The private key is kept secret and known only to the attacker. <br />
# When the malware is run on the victim’s computer, a random symmetric key is created locally and used to encrypt all of the victim’s files. This symmetric key is then itself encrypted by the public key in the malware and generates an asymmetric ciphertext. A message is sent to the victim with the asymmetric ciphertext and information on how to pay the ransom. The victim then sends both payment and the asymmetric ciphertext to the attacker. <br />
# When the ransom is received, the attacker uses the private key to decrypt the asymmetric ciphertext to reveal the victim’s symmetric key. The symmetric key is sent to the victim.<br />
# The victim then uses the symmetric key to decrypt the files. [8]<br />
<br />
== How ransomware infects computers == <br />
* Email – Emails may contain infected attachments or links to infected websites.<br />
* Compromised Websites – Websites may have exploit kits which can infect a computer without any clicking. These websites contain malicious code that take advantage of vulnerabilities in software or browsers. If such a vulnerability exists (e.g., software patches that are not up to date), the exploit kit uses the vulnerability to download ransomware. [9] [10] [11] Even visiting reputable websites can expose a victim to exploit kits. For example, in 2016, malicious advertisements containing exploit kits affected The New York Times, the BBC, MSN, and AOL. [12]<br />
* Wormlike behavior – Certain ransomware uses a computer’s software vulnerabilities to spread throughout networks. For example, WannaCry and Petya spread via EternalBlue MS17-010. It exploited a vulnerability in Microsoft Windows operating system, specifically the network file sharing protocol Server Message Block 1.0 (SMB). This vulnerability allowed “applications on a computer to read and write to file and request services”, and the ransomware was distributed throughout local networks without any user action. Computers without the appropriate security patch were then infected and could spread the ransomware further. [13] [14] <br />
<br />
== Ransomware targets healthcare == <br />
The healthcare industry is a prime target for cyberattacks such as ransomware for many reasons. <br />
=== Ease of attack ===<br />
Hospital networks are quickly expanding to meet government requirements such as increased electronic health record information exchange. [15] However, the cybersecurity of these networks is not as robust as that of other industries like finance. The primary focus of healthcare IT systems is often patient care and rapid accessibility rather than cybersecurity [16][17]. In fact, it is estimated that less than 5% of hospital IT budgets are spent on security and there are often long delays before security patches are implemented [18] [19]. Hospitals are thus seen as “soft targets.”<br />
=== Hospitals are more likely to pay ransom ===<br />
Hospitals depend on rapid access to data in order to provide patient care. Ransomware attacks can result in compromised delivery of healthcare and lawsuits if patients suffer harm from delayed or cancelled appointments and procedures. This makes hospitals more likely to pay ransom to quickly regain access to critical and often irreplaceable data. [6] [20] <br />
=== Healthcare data is valuable ===<br />
Health data includes sensitive information such as social security numbers, insurance details, addresses, etc. Attackers can use this extensive information to perpetrate medical fraud and identity theft, access financial information, and extort money by threatening to reveal a victim’s personal history (15). The variety of possible criminal uses makes healthcare data valuable. A single patient’s health record can be sold on the black market for between $1.50 and $10. [21] This is up to ten times more valuable than a person’s credit card details. [22] <br />
However, this black market price of a single complete health record has actually fallen in 2016 due to the growing supply of breached healthcare data. (In 2015, the Department of Health and Human Services’ Office for Civil Rights estimates 113 million healthcare records were breached. [23] Before these large breaches, in 2012, a single record used to fetch $50 to $60 dollars. This fall in health record price has actually encouraged the number of ransomware attacks as cybercriminals need to steal more health records (or extort ransom) in order to achieve the same profit. [21]<br />
<br />
<br />
The threat of ransomware to healthcare organizations is only expected to grow. The Verizon DBIR 2017 report showed that healthcare was the number two industry target for ransomware, behind Public Administration and ahead of Financial Services. In 2017, 72% of all malware incidents in the healthcare sector involved ransomware. [16] And the 2017 Experian Data Breach Industry Forecast report predicts that healthcare organizations will become the industry most heavily targeted by cybercriminals. [24] <br />
<br />
== Notable ransomware attacks on healthcare systems == <br />
<br />
* February 5, 2016 – Hollywood Presbyterian Medical Center, a 434-bed acute care hospital, experienced a Locky ransomware attack and lost access to its computer systems. This caused severe disruptions and hospital staff had to rely on pen-and-paper. The systems were restored after the Hollywood Presbyterian paid the attackers $17,000 in bitcoin ransom. [25]<br />
<br />
* March 28, 2016 – 10 hospitals and 250 outpatient centers in the MedStar network, Washington DC were affected by ransomware, forcing a temporary shutdown of electronic health and email systems. [26]<br />
<br />
* March 2016 – Methodist Hospital in Henderson, KY was affected by ransomware and declared an “internal state of emergency” for five days until data was restored from backups. [6] [27]<br />
<br />
* March 18, 2016 – Chino Valley Medical Center and Desert Valley Hospital in Southern CA were attacked by ransomware. Affected computers and some hospital servers were temporarily taken offline in order to prevent further spread. Patient health records were not compromised but the attack caused significant disruption. [28]<br />
<br />
* 2017 – UK National Health Service – The WannaCry ransomware variant affected 48 UK NHS hospital trusts. Doctor’s offices were shut down, affected hospitals diverted patients to other facilities, and non-critical appointments and surgeries were canceled. [29]<br />
<br />
* May 2017 – The first reports emerged of ransomware compromising medical devices in US hospitals. These attacks affected Bayer Medrad Windows-based devices [30]<br />
<br />
<br />
<br />
== WannaCry: Attack on the NHS – a primary care practice perspective ==<br />
--[[User:Samsun|Samsun]] ([[User talk:Samsun|talk]]) 22:51, 27 October 2020 (UTC)<br />
<br />
On May 12th, 2017, global ransomware called WannaCry locked out over 230,000 computers in at least 150 countries, including the NHS in the U.K.[35]. Although the NHS was not the primary target, this cyber attack directly affected 34 percent of the hospital trusts and 8 percent of primary care practices, causing significant disruption to the services due to the cancellation of thousands of patient visits and operations. During this time, primary care practices, although not directly affected, had to shut down the computer system to prevent any further spread. So, the practices had to resort to manual processes of recording notes, reporting test results, and referrals, not to mention managing the disgruntled patients, the subsequent backlog it created, especially catching up with the sudden influx of test results and letters and the time spend input all of the handwritten notes into the Electronic Health Record (EHR). <br />
<br />
It was reported that this ransomware, which exploited a known weakness in computers running Windows, could have been prevented had security updates from Microsoft were applied promptly, a robust firewall been set up on the NHS broadband network, and legacy platforms like Windows XP were updated to newer operating systems. No ransom was reportedly paid, and the malicious software was halted in the evening of the same day when an independent cybersecurity researcher inadvertently found and activated an inbuilt “kill-switch”[36]. Although a patch was released by Microsoft the following day, some primary care practices had to wait almost seven days before it was applied to their system, causing further disruption of services.<br />
<br />
A report published by the National Audit Office[37] highlighted that though the Department of Health had a plan to deal with such a situation, this had not been tested at a local level. The NHS had also not rehearsed for such a cyberattack, which led to the initial confusion as to who would lead the response to the attack. Though the need for maintaining emergency care was identified as a priority, there was a lack of clear and timely communication with all the relevant stakeholders. It is estimated that the WannaCry ransomware attack cost the NHS £92 million, which included £20 million due to lost outputs from canceled appointment and operations, and a further £72 million to deal with the aftermath related to the recovery of the data and the restoration of the systems[38].<br />
<br />
NHS England, in its report[35], acknowledged the inadequacies within the system and highlighted plans to strengthen NHS' cyber-security, based on the key lessons that were learned from the incident. These included developing a response plan in the event of a cyberattack and establishing the resources' roles and responsibilities. It also emphasized the need to have regular monitoring of all software, ensure that they are up to date, any critical patches are applied promptly, and ensure essential and timely communication with all relevant stakeholders. Above all, it emphasized leaders, organizations, and their staff's responsibility in taking cyber threats seriously, understanding the associated risks, and proactively taking measures to mitigate these risks.<br />
<br />
NHS Digital produced a Data Security Standards guide, which layouts ten standards to mitigate the risk of a future cyberattack, addressing issues around the three main entities – people, process, and technology. The fundamentals of it being:<br />
'''People:''' ensure staff is equipped to handle information respectfully and safely, according to the Caldicott Principles.<br />
'''Process:''' ensure the organization proactively prevents data security breaches and responds appropriately to incidents or near misses.<br />
'''Technology:''' ensure technology is secure and up-to-date.<br />
<br />
Also, the Department of Health and Social care reported in 2018 that the NHS would spend £150 million to bolster its cybersecurity to prevent a further cyberattack like the WannaCry[39]. A subsequent report by Comparitech[40], a company that provides consumers privacy information, tools, and comparisons, underlines a relative reduction in the number of recent cyberattacks in the U.K., which according to them, could be a result of the “effective” measures implemented to thwart another cyberattack, with increased spending on measures to improve cybersecurity, practices, and training for their staff.<br />
<br />
== Impact of ransomware attacks on health systems == <br />
Ransomware attacks in healthcare systems are extremely damaging. First they endanger patient safety by preventing access to critical information in the medical record – e.g., allergies, medication lists, lab results, treatment plans, etc. Without this information, medical care can be rendered incorrectly or delayed. [20]<br />
<br />
'''Legal ramifications for hospitals'''<br />
<br />
As a result of the attack, a hospital may be subject to government action under the HIPAA Security Rule. [20] [31] A ransomware attack is considered a “security incident” defined as “attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.” Due to the increasing frequency of ransomware attacks, the U.S. Department of Health and Human Services released a fact sheet giving detailed guidance regarding ransomware and requirements such as reporting of security incidents. [32] This fact sheet clarified that a ransomware infection is considered a HIPAA breach, defined as “… the acquisition, access, use, or disclosure of PHI in a manner not permitted under the [HIPAA Privacy Rule] which comprises the security or privacy of the PHI.” [33] Specifically, ransomware encryption of protected health information is a breach since the data “was acquired (i.e., unauthorized individuals have taken possession or control of the information), and thus is a ‘disclosure’ not permitted under the HIPAA Privacy Rule.” [32]<br />
<br />
== How to prevent ransomware infections ==<br />
* Keep software updated with patches and security updates – this leaves fewer vulnerabilities for malware to exploit<br />
* Run antivirus software and keep it up-to-date <br />
* Do not click pop-up windows or links in suspicious emails. <br />
* Back up data so that if a system becomes infected, the data can be restored. <br />
* Have an organizational security plan<br />
# Set a companywide schedule for computers to get the latest software updates<br />
# Educate employees on security awareness and data hygiene [34]<br />
<br />
<br />
<br />
== References ==<br />
<br />
# Ransomware. Trend Micro. Published 2017. https://www.trendmicro.com/vinfo/us/security/definition/Ransomware.<br />
# Geier E. How to rescue your PC from ransomware. PCWorld. Published April 3, 2017. https://www.pcworld.com/article/2084002/security/how-to-rescue-your-pc-from-ransomware.html<br />
# Nagpal B, Wadhwa V. (2016) Cryptoviral Extortion: Evolution, Scenarios, and Analysis. In: Lobiyal D, Mohapatra D, Nagar A, Sahoo M. (eds) Proceedings of the International Conference on Signal, Networks, Computing, and Systems. Lecture Notes in Electrical Engineering, vol 396. Springer, New Delhi<br />
# Wilding E., Skulason F. (eds) Virus bulletin. The authoritative international publication on computer virus prevention, recognition, and removal. Published Jan 1990. https://www.virusbulletin.com/uploads/pdf/magazine/1990/199001.pdf <br />
# Young, A, Yung M. (1996). Cryptovirology: extortion-based security threats and countermeasures. IEEE Symposium on Security and Privacy. pp. 129–140. ISBN 0-8186-7417-2. doi:10.1109/SECPRI.1996.502676<br />
# Zetter Kim. Why hospitals are the perfect targets for ransomware. Wired. Published Mar. 30, 2016. https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/<br />
# Kappuswamy P, Al-Khalidi SQY. Hybrid encryption/decryption technique using new public key and symmetric key algorithm. MIS Review Vol. 19, No. 2, March (2014), pp. 1-13 DOI: 10.6131/MISR.2014.1902.01 https://pdfs.semanticscholar.org/87ff/ea85fbf52e22e4808e1fcc9e40ead4ff7738.pdf<br />
# Can files locked by WannaCry be decrypted: a technical analysis. Symantec. https://medium.com/threat-intel/wannacry-ransomware-decryption-821c7e3f0a2b<br />
# Crowe J. Ransomware FAQ: how ransomware infects your computer. Barkly. https://blog.barkly.com/how-ransomware-infects-computers#infection Published Sept 2016. <br />
# How ransomware infects computers. McAfee. https://www.mcafee.com/us/security-awareness/articles/how-ransomware-infects-computers.aspx<br />
# Ransomware FAQ. Windows Defender Security Intelligence. https://www.microsoft.com/en-us/wdsi/threats/ransomware<br />
# Goodin, D. Big-name sites hit by rash of malicious ads spreading crypto ransomware. Ars Technica. Published Mar 15, 2016. https://arstechnica.com/information-technology/2016/03/big-name-sites-hit-by-rash-of-malicious-ads-spreading-crypto-ransomware/<br />
# Grobman, S. WannaCry: the old worms and the new. McAfee. https://securingtomorrow.mcafee.com/executive-perspectives/wannacry-old-worms-new/ Published May 12, 2017.<br />
# Burgess, M. Everything you need to know about EternalBlue – the NSA exploit linked to Petya. Wired. Published June 28, 2017. https://www.wired.co.uk/article/what-is-eternal-blue-exploit-vulnerability-patch<br />
# Kruse CS, Frederick B, Jacobson T, Monticone DK. 2017. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technology and Health Care 25 (2017) 1-10. <br />
# 2017 Data breach investigations report. 10th ed. Verizon. http://www.verizonenterprise.com/verizon-insights-lab/dbir/2017/<br />
# Bai G, Jiang J, Flasher R. Hospital risk of data breaches. JAMA Intern Med. 2017;177(6):878-880. doi:10.1001/jamainternmed.2017.0336<br />
# AHC Media LLC. Hackers target hospitals with “ransomware”. ED LEGAL LETT. 2016 Apr; 27(4): also available https://www.ahcmedia.com/articles/137468-hackers-target-hospitals-with-ransomware<br />
# Newman, LH. The ransomware meltdown experts warned about is here. Wired. Published May 12, 2017. https://www.wired.com/2017/05/ransomware-meltdown-experts-warned/<br />
# Cohen IG, Hoffman S, Adashi EY. Your money or your patient’s life? Ransomware and electronic health records. Ann Intern Med. 2017;167(8):587-588<br />
# Increase in ransomware and cyberattacks linked to fall in price of health data. HIPAA Journal. Dec 2016. www.hipaajournal.com/increase-in-ransomware-and-cyberattacks-linked-to-fall-in-price-of-health-data-8622.<br />
# Chinthapalli K. The hackers holding hospitals to ransom. BMJ 2017;357:j2214<br />
# 2015: the year of the healthcare data breach. HIPAA Journal. Published Dec. 29, 2015. https://www.hipaajournal.com/2015-the-year-of-the-healthcare-data-breach-8239/<br />
# Fourth annual 2017 Data Breach industry forecast. Experian. https://www.experian.com/assets/data-breach/white-papers/2017-experian-data-breach-industry-forecast.pdf<br />
# Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Published Feb 18, 2016. http://www.latimes.com/business/technology/la-me-ln-hollywood-hospital-bitcoin-20160217-story.html<br />
# Virus forces shutdown of Medstar Health System’s 10-hospital computer network. HIPAA Journal. Published Mar. 29, 2016. https://www.hipaajournal.com/virus-forces-shutdown-medstar-health-systems-10-hospital-computer-network-3372/<br />
# Monegain B. Methodist Hospital recovering from five day ransomware attack, claims it did not pay up. HealthcareITNews. Published Mar. 22, 2016. http://www.healthcareitnews.com/news/methodist-hospital-recovering-five-day-ransomware-attack-claims-it-did-not-pay<br />
# Two more Californian hospital ransomware attacks reported. HIPAA Journal. Published Mar. 23, 2016. https://www.hipaajournal.com/two-more-californian-hospital-ransomware-attacks-reported-3368/<br />
# Erlanger S, Bilefsky D, Chan S. U.K. Health Service ignored warnings for months. The New York Times. Published May 12, 2017. https://www.nytimes.com/2017/05/12/world/europe/nhs-cyberattack-warnings.html<br />
# Fox-Brewster, T. Medical devices hit by ransomware for the first time in US hospitals. Forbes. Published May 17, 2017. https://www.forbes.com/sites/thomasbrewster/2017/05/17/wannacry-ransomware-hit-real-medical-devices/#75b8806b425c<br />
# Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-91 (1996).<br />
# Department of Health and Human Services. Fact Sheet: Ransomware and HIPAA. Accessed at www.hhs.gov/sites/default/files/RansomwareFactSheet.pdf on 26 May 2017.<br />
# 45 C.F.R. § 164.302-.318 (2016).<br />
# Chen, BX. How to protect yourself from ransomware attacks. The New York Times. Published May 15, 2017. https://www.nytimes.com/2017/05/15/technology/personaltech/heres-how-to-protect-yourself-from-ransomware-attacks.html<br />
# W. Smart and S. House, “Lessons learned review of the WannaCry Ransomware Cyber Attack,” p. 42.<br />
# N. K. O. S. in S. Francisco, “‘Accidental hero’ halts ransomware attack and warns: this is not over,” The Guardian, May 13, 2017.<br />
# “Investigation-WannaCry-cyber-attack-and-the-NHS.pdf.” Accessed: Sep. 02, 2020. [Online]. Available: https://www.nao.org.uk/wp-content/uploads/2017/10/Investigation-WannaCry-cyber-attack-and-the-NHS.pdf.<br />
# “Department of Health and Social Care puts cost of WannaCry to NHS at £92m,” Digital Health, Oct. 12, 2018. https://www.digitalhealth.net/2018/10/dhsc-puts-cost-wannacry-nhs-92m/ (accessed Sep. 02, 2020).<br />
# “NHS to spend £150m on cyber security to bolster defences after WannaCry attack.” https://www.independent.co.uk/news/health/cyber-attacks-nhs-wannacry-security-investment-microsoft-a8327091.html (accessed Sep. 02, 2020).<br />
# “Ransomware Attacks on Hospitals & Healthcare Cost $157m since 2016,” Comparitech, Feb. 11, 2020. https://www.comparitech.com/blog/information-security/ransomware-attacks-hospitals-data/ (accessed Sep. 01, 2020).<br />
<br />
<br />
<br />
Submitted by Abigail Huang<br />
[[Category:BMI512-FALL-17]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/RansomwareRansomware2020-10-27T22:58:14Z<p>Samsun: </p>
<hr />
<div>'''Ransomware''' is a type of [[malware|malware]] (malicious software) that limits users from accessing all or part of their computer unless a ransom is paid, often in the form of cryptocurrency such as Bitcoin.<br />
Some forms of ransomware lock a computer’s screen and display a demand for payment. [1] The victim’s files remain untouched, however, and this form of ransomware can sometimes be removed without paying the attacker. [2] Newer ransomware called ''cryptoviral extortion'' encrypts a user’s files. This more advanced form of malware renders files inaccessible even if the malware is removed. [3] Thus, the victim must pay the attacker for the decryption key in order to regain access to his files. <br />
<br />
== History of encrypting ransomware ==<br />
In 1989, Joseph Popp created the first known encrypting malware called the “AIDS Trojan” which was distributed on floppy disks via snail mail. This malware was limited in its design. The AIDS Trojan only encrypted the names of files and not the files themselves. Furthermore, the trojan used symmetric encryption (where the same key is used to encrypt and decrypt files) and the decryption key could be extracted from the code of the trojan. This made it unnecessary to pay ransom to reverse the effects of the trojan. [4]<br />
<br />
The idea of using asymmetric or public key [[encryption|encryption]] was introduced by researchers Adam L. Young and Moti Yung 1996 at an IEEE symposium. [5] Actual ransomware using this scheme became increasingly common after 2005. [6] In asymmetric encryption, a different key is used for encryption (the public key) and for decryption (the private key). The public key is used to encrypt the victim’s files while the private key is known only to the creators of the ransomware. The ransomware’s effects cannot be overcome without paying for the private key. [5]<br />
<br />
== Mechanism of encryption ==<br />
More recent malware such as CryptoLocker and WannaCry use a hybrid model combining asymmetric and symmetric encryption to capitalize on the strengths of both schemes. Using asymmetric keys allows the attackers to keep the private key secret. Symmetric keys allow encryption to occur more efficiently, enabling victim files to rapidly be encrypted. [7] <br />
# The attacker creates a key pair. The public key is placed in the code of the malware. The private key is kept secret and known only to the attacker. <br />
# When the malware is run on the victim’s computer, a random symmetric key is created locally and used to encrypt all of the victim’s files. This symmetric key is then itself encrypted by the public key in the malware and generates an asymmetric ciphertext. A message is sent to the victim with the asymmetric ciphertext and information on how to pay the ransom. The victim then sends both payment and the asymmetric ciphertext to the attacker. <br />
# When the ransom is received, the attacker uses the private key to decrypt the asymmetric ciphertext to reveal the victim’s symmetric key. The symmetric key is sent to the victim.<br />
# The victim then uses the symmetric key to decrypt the files. [8]<br />
<br />
== How ransomware infects computers == <br />
* Email – Emails may contain infected attachments or links to infected websites.<br />
* Compromised Websites – Websites may have exploit kits which can infect a computer without any clicking. These websites contain malicious code that take advantage of vulnerabilities in software or browsers. If such a vulnerability exists (e.g., software patches that are not up to date), the exploit kit uses the vulnerability to download ransomware. [9] [10] [11] Even visiting reputable websites can expose a victim to exploit kits. For example, in 2016, malicious advertisements containing exploit kits affected The New York Times, the BBC, MSN, and AOL. [12]<br />
* Wormlike behavior – Certain ransomware uses a computer’s software vulnerabilities to spread throughout networks. For example, WannaCry and Petya spread via EternalBlue MS17-010. It exploited a vulnerability in Microsoft Windows operating system, specifically the network file sharing protocol Server Message Block 1.0 (SMB). This vulnerability allowed “applications on a computer to read and write to file and request services”, and the ransomware was distributed throughout local networks without any user action. Computers without the appropriate security patch were then infected and could spread the ransomware further. [13] [14] <br />
<br />
== Ransomware targets healthcare == <br />
The healthcare industry is a prime target for cyberattacks such as ransomware for many reasons. <br />
=== Ease of attack ===<br />
Hospital networks are quickly expanding to meet government requirements such as increased electronic health record information exchange. [15] However, the cybersecurity of these networks is not as robust as that of other industries like finance. The primary focus of healthcare IT systems is often patient care and rapid accessibility rather than cybersecurity [16][17]. In fact, it is estimated that less than 5% of hospital IT budgets are spent on security and there are often long delays before security patches are implemented [18] [19]. Hospitals are thus seen as “soft targets.”<br />
=== Hospitals are more likely to pay ransom ===<br />
Hospitals depend on rapid access to data in order to provide patient care. Ransomware attacks can result in compromised delivery of healthcare and lawsuits if patients suffer harm from delayed or cancelled appointments and procedures. This makes hospitals more likely to pay ransom to quickly regain access to critical and often irreplaceable data. [6] [20] <br />
=== Healthcare data is valuable ===<br />
Health data includes sensitive information such as social security numbers, insurance details, addresses, etc. Attackers can use this extensive information to perpetrate medical fraud and identity theft, access financial information, and extort money by threatening to reveal a victim’s personal history (15). The variety of possible criminal uses makes healthcare data valuable. A single patient’s health record can be sold on the black market for between $1.50 and $10. [21] This is up to ten times more valuable than a person’s credit card details. [22] <br />
However, this black market price of a single complete health record has actually fallen in 2016 due to the growing supply of breached healthcare data. (In 2015, the Department of Health and Human Services’ Office for Civil Rights estimates 113 million healthcare records were breached. [23] Before these large breaches, in 2012, a single record used to fetch $50 to $60 dollars. This fall in health record price has actually encouraged the number of ransomware attacks as cybercriminals need to steal more health records (or extort ransom) in order to achieve the same profit. [21]<br />
<br />
<br />
The threat of ransomware to healthcare organizations is only expected to grow. The Verizon DBIR 2017 report showed that healthcare was the number two industry target for ransomware, behind Public Administration and ahead of Financial Services. In 2017, 72% of all malware incidents in the healthcare sector involved ransomware. [16] And the 2017 Experian Data Breach Industry Forecast report predicts that healthcare organizations will become the industry most heavily targeted by cybercriminals. [24] <br />
<br />
== Notable ransomware attacks on healthcare systems == <br />
<br />
* February 5, 2016 – Hollywood Presbyterian Medical Center, a 434-bed acute care hospital, experienced a Locky ransomware attack and lost access to its computer systems. This caused severe disruptions and hospital staff had to rely on pen-and-paper. The systems were restored after the Hollywood Presbyterian paid the attackers $17,000 in bitcoin ransom. [25]<br />
<br />
* March 28, 2016 – 10 hospitals and 250 outpatient centers in the MedStar network, Washington DC were affected by ransomware, forcing a temporary shutdown of electronic health and email systems. [26]<br />
<br />
* March 2016 – Methodist Hospital in Henderson, KY was affected by ransomware and declared an “internal state of emergency” for five days until data was restored from backups. [6] [27]<br />
<br />
* March 18, 2016 – Chino Valley Medical Center and Desert Valley Hospital in Southern CA were attacked by ransomware. Affected computers and some hospital servers were temporarily taken offline in order to prevent further spread. Patient health records were not compromised but the attack caused significant disruption. [28]<br />
<br />
* 2017 – UK National Health Service – The WannaCry ransomware variant affected 48 UK NHS hospital trusts. Doctor’s offices were shut down, affected hospitals diverted patients to other facilities, and non-critical appointments and surgeries were canceled. [29]<br />
<br />
* May 2017 – The first reports emerged of ransomware compromising medical devices in US hospitals. These attacks affected Bayer Medrad Windows-based devices [30]<br />
<br />
<br />
<br />
== WannaCry: Attack on the NHS – a primary care practice perspective ==<br />
--[[User:Samsun|Samsun]] ([[User talk:Samsun|talk]]) 22:51, 27 October 2020 (UTC)<br />
<br />
On May 12th, 2017, global ransomware called WannaCry locked out over 230,000 computers in at least 150 countries, including the NHS in the U.K.[1]. Although the NHS was not the primary target, this cyber attack directly affected 34 percent of the hospital trusts and 8 percent of primary care practices, causing significant disruption to the services due to the cancellation of thousands of patient visits and operations. During this time, primary care practices, although not directly affected, had to shut down the computer system to prevent any further spread. So, the practices had to resort to manual processes of recording notes, reporting test results, and referrals, not to mention managing the disgruntled patients, the subsequent backlog it created, especially catching up with the sudden influx of test results and letters and the time spend input all of the handwritten notes into the Electronic Health Record (EHR). <br />
<br />
It was reported that this ransomware, which exploited a known weakness in computers running Windows, could have been prevented had security updates from Microsoft were applied promptly, a robust firewall been set up on the NHS broadband network, and legacy platforms like Windows XP were updated to newer operating systems. No ransom was reportedly paid, and the malicious software was halted in the evening of the same day when an independent cybersecurity researcher inadvertently found and activated an inbuilt “kill-switch”[2]. Although a patch was released by Microsoft the following day, some primary care practices had to wait almost seven days before it was applied to their system, causing further disruption of services.<br />
<br />
A report published by the National Audit Office[3] highlighted that though the Department of Health had a plan to deal with such a situation, this had not been tested at a local level. The NHS had also not rehearsed for such a cyberattack, which led to the initial confusion as to who would lead the response to the attack. Though the need for maintaining emergency care was identified as a priority, there was a lack of clear and timely communication with all the relevant stakeholders. It is estimated that the WannaCry ransomware attack cost the NHS £92 million, which included £20 million due to lost outputs from canceled appointment and operations, and a further £72 million to deal with the aftermath related to the recovery of the data and the restoration of the systems[4].<br />
<br />
NHS England, in its report[1], acknowledged the inadequacies within the system and highlighted plans to strengthen NHS' cyber-security, based on the key lessons that were learned from the incident. These included developing a response plan in the event of a cyberattack and establishing the resources' roles and responsibilities. It also emphasized the need to have regular monitoring of all software, ensure that they are up to date, any critical patches are applied promptly, and ensure essential and timely communication with all relevant stakeholders. Above all, it emphasized leaders, organizations, and their staff's responsibility in taking cyber threats seriously, understanding the associated risks, and proactively taking measures to mitigate these risks.<br />
<br />
NHS Digital produced a Data Security Standards guide, which layouts ten standards to mitigate the risk of a future cyberattack, addressing issues around the three main entities – people, process, and technology. The fundamentals of it being:<br />
'''People:''' ensure staff is equipped to handle information respectfully and safely, according to the Caldicott Principles.<br />
'''Process:''' ensure the organization proactively prevents data security breaches and responds appropriately to incidents or near misses.<br />
'''Technology:''' ensure technology is secure and up-to-date.<br />
<br />
Also, the Department of Health and Social care reported in 2018 that the NHS would spend £150 million to bolster its cybersecurity to prevent a further cyberattack like the WannaCry[5]. A subsequent report by Comparitech[6], a company that provides consumers privacy information, tools, and comparisons, underlines a relative reduction in the number of recent cyberattacks in the U.K., which according to them, could be a result of the “effective” measures implemented to thwart another cyberattack, with increased spending on measures to improve cybersecurity, practices, and training for their staff.<br />
<br />
== Impact of ransomware attacks on health systems == <br />
Ransomware attacks in healthcare systems are extremely damaging. First they endanger patient safety by preventing access to critical information in the medical record – e.g., allergies, medication lists, lab results, treatment plans, etc. Without this information, medical care can be rendered incorrectly or delayed. [20]<br />
<br />
'''Legal ramifications for hospitals'''<br />
<br />
As a result of the attack, a hospital may be subject to government action under the HIPAA Security Rule. [20] [31] A ransomware attack is considered a “security incident” defined as “attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.” Due to the increasing frequency of ransomware attacks, the U.S. Department of Health and Human Services released a fact sheet giving detailed guidance regarding ransomware and requirements such as reporting of security incidents. [32] This fact sheet clarified that a ransomware infection is considered a HIPAA breach, defined as “… the acquisition, access, use, or disclosure of PHI in a manner not permitted under the [HIPAA Privacy Rule] which comprises the security or privacy of the PHI.” [33] Specifically, ransomware encryption of protected health information is a breach since the data “was acquired (i.e., unauthorized individuals have taken possession or control of the information), and thus is a ‘disclosure’ not permitted under the HIPAA Privacy Rule.” [32]<br />
<br />
== How to prevent ransomware infections ==<br />
* Keep software updated with patches and security updates – this leaves fewer vulnerabilities for malware to exploit<br />
* Run antivirus software and keep it up-to-date <br />
* Do not click pop-up windows or links in suspicious emails. <br />
* Back up data so that if a system becomes infected, the data can be restored. <br />
* Have an organizational security plan<br />
# Set a companywide schedule for computers to get the latest software updates<br />
# Educate employees on security awareness and data hygiene [34]<br />
<br />
<br />
<br />
== References ==<br />
<br />
# Ransomware. Trend Micro. Published 2017. https://www.trendmicro.com/vinfo/us/security/definition/Ransomware.<br />
# Geier E. How to rescue your PC from ransomware. PCWorld. Published April 3, 2017. https://www.pcworld.com/article/2084002/security/how-to-rescue-your-pc-from-ransomware.html<br />
# Nagpal B, Wadhwa V. (2016) Cryptoviral Extortion: Evolution, Scenarios, and Analysis. In: Lobiyal D, Mohapatra D, Nagar A, Sahoo M. (eds) Proceedings of the International Conference on Signal, Networks, Computing, and Systems. Lecture Notes in Electrical Engineering, vol 396. Springer, New Delhi<br />
# Wilding E., Skulason F. (eds) Virus bulletin. The authoritative international publication on computer virus prevention, recognition, and removal. Published Jan 1990. https://www.virusbulletin.com/uploads/pdf/magazine/1990/199001.pdf <br />
# Young, A, Yung M. (1996). Cryptovirology: extortion-based security threats and countermeasures. IEEE Symposium on Security and Privacy. pp. 129–140. ISBN 0-8186-7417-2. doi:10.1109/SECPRI.1996.502676<br />
# Zetter Kim. Why hospitals are the perfect targets for ransomware. Wired. Published Mar. 30, 2016. https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/<br />
# Kappuswamy P, Al-Khalidi SQY. Hybrid encryption/decryption technique using new public key and symmetric key algorithm. MIS Review Vol. 19, No. 2, March (2014), pp. 1-13 DOI: 10.6131/MISR.2014.1902.01 https://pdfs.semanticscholar.org/87ff/ea85fbf52e22e4808e1fcc9e40ead4ff7738.pdf<br />
# Can files locked by WannaCry be decrypted: a technical analysis. Symantec. https://medium.com/threat-intel/wannacry-ransomware-decryption-821c7e3f0a2b<br />
# Crowe J. Ransomware FAQ: how ransomware infects your computer. Barkly. https://blog.barkly.com/how-ransomware-infects-computers#infection Published Sept 2016. <br />
# How ransomware infects computers. McAfee. https://www.mcafee.com/us/security-awareness/articles/how-ransomware-infects-computers.aspx<br />
# Ransomware FAQ. Windows Defender Security Intelligence. https://www.microsoft.com/en-us/wdsi/threats/ransomware<br />
# Goodin, D. Big-name sites hit by rash of malicious ads spreading crypto ransomware. Ars Technica. Published Mar 15, 2016. https://arstechnica.com/information-technology/2016/03/big-name-sites-hit-by-rash-of-malicious-ads-spreading-crypto-ransomware/<br />
# Grobman, S. WannaCry: the old worms and the new. McAfee. https://securingtomorrow.mcafee.com/executive-perspectives/wannacry-old-worms-new/ Published May 12, 2017.<br />
# Burgess, M. Everything you need to know about EternalBlue – the NSA exploit linked to Petya. Wired. Published June 28, 2017. https://www.wired.co.uk/article/what-is-eternal-blue-exploit-vulnerability-patch<br />
# Kruse CS, Frederick B, Jacobson T, Monticone DK. 2017. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technology and Health Care 25 (2017) 1-10. <br />
# 2017 Data breach investigations report. 10th ed. Verizon. http://www.verizonenterprise.com/verizon-insights-lab/dbir/2017/<br />
# Bai G, Jiang J, Flasher R. Hospital risk of data breaches. JAMA Intern Med. 2017;177(6):878-880. doi:10.1001/jamainternmed.2017.0336<br />
# AHC Media LLC. Hackers target hospitals with “ransomware”. ED LEGAL LETT. 2016 Apr; 27(4): also available https://www.ahcmedia.com/articles/137468-hackers-target-hospitals-with-ransomware<br />
# Newman, LH. The ransomware meltdown experts warned about is here. Wired. Published May 12, 2017. https://www.wired.com/2017/05/ransomware-meltdown-experts-warned/<br />
# Cohen IG, Hoffman S, Adashi EY. Your money or your patient’s life? Ransomware and electronic health records. Ann Intern Med. 2017;167(8):587-588<br />
# Increase in ransomware and cyberattacks linked to fall in price of health data. HIPAA Journal. Dec 2016. www.hipaajournal.com/increase-in-ransomware-and-cyberattacks-linked-to-fall-in-price-of-health-data-8622.<br />
# Chinthapalli K. The hackers holding hospitals to ransom. BMJ 2017;357:j2214<br />
# 2015: the year of the healthcare data breach. HIPAA Journal. Published Dec. 29, 2015. https://www.hipaajournal.com/2015-the-year-of-the-healthcare-data-breach-8239/<br />
# Fourth annual 2017 Data Breach industry forecast. Experian. https://www.experian.com/assets/data-breach/white-papers/2017-experian-data-breach-industry-forecast.pdf<br />
# Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Published Feb 18, 2016. http://www.latimes.com/business/technology/la-me-ln-hollywood-hospital-bitcoin-20160217-story.html<br />
# Virus forces shutdown of Medstar Health System’s 10-hospital computer network. HIPAA Journal. Published Mar. 29, 2016. https://www.hipaajournal.com/virus-forces-shutdown-medstar-health-systems-10-hospital-computer-network-3372/<br />
# Monegain B. Methodist Hospital recovering from five day ransomware attack, claims it did not pay up. HealthcareITNews. Published Mar. 22, 2016. http://www.healthcareitnews.com/news/methodist-hospital-recovering-five-day-ransomware-attack-claims-it-did-not-pay<br />
# Two more Californian hospital ransomware attacks reported. HIPAA Journal. Published Mar. 23, 2016. https://www.hipaajournal.com/two-more-californian-hospital-ransomware-attacks-reported-3368/<br />
# Erlanger S, Bilefsky D, Chan S. U.K. Health Service ignored warnings for months. The New York Times. Published May 12, 2017. https://www.nytimes.com/2017/05/12/world/europe/nhs-cyberattack-warnings.html<br />
# Fox-Brewster, T. Medical devices hit by ransomware for the first time in US hospitals. Forbes. Published May 17, 2017. https://www.forbes.com/sites/thomasbrewster/2017/05/17/wannacry-ransomware-hit-real-medical-devices/#75b8806b425c<br />
# Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-91 (1996).<br />
# Department of Health and Human Services. Fact Sheet: Ransomware and HIPAA. Accessed at www.hhs.gov/sites/default/files/RansomwareFactSheet.pdf on 26 May 2017.<br />
# 45 C.F.R. § 164.302-.318 (2016).<br />
# Chen, BX. How to protect yourself from ransomware attacks. The New York Times. Published May 15, 2017. https://www.nytimes.com/2017/05/15/technology/personaltech/heres-how-to-protect-yourself-from-ransomware-attacks.html<br />
# W. Smart and S. House, “Lessons learned review of the WannaCry Ransomware Cyber Attack,” p. 42.<br />
[2] N. K. O. S. in S. Francisco, “‘Accidental hero’ halts ransomware attack and warns: this is not over,” The Guardian, May 13, 2017.<br />
[3] “Investigation-WannaCry-cyber-attack-and-the-NHS.pdf.” Accessed: Sep. 02, 2020. [Online]. Available: https://www.nao.org.uk/wp-content/uploads/2017/10/Investigation-WannaCry-cyber-attack-and-the-NHS.pdf.<br />
[4] “Department of Health and Social Care puts cost of WannaCry to NHS at £92m,” Digital Health, Oct. 12, 2018. https://www.digitalhealth.net/2018/10/dhsc-puts-cost-wannacry-nhs-92m/ (accessed Sep. 02, 2020).<br />
[5] “NHS to spend £150m on cyber security to bolster defences after WannaCry attack.” https://www.independent.co.uk/news/health/cyber-attacks-nhs-wannacry-security-investment-microsoft-a8327091.html (accessed Sep. 02, 2020).<br />
[6] “Ransomware Attacks on Hospitals & Healthcare Cost $157m since 2016,” Comparitech, Feb. 11, 2020. https://www.comparitech.com/blog/information-security/ransomware-attacks-hospitals-data/ (accessed Sep. 01, 2020).<br />
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<br />
<br />
Submitted by Abigail Huang<br />
[[Category:BMI512-FALL-17]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/RansomwareRansomware2020-10-27T22:57:39Z<p>Samsun: </p>
<hr />
<div>'''Ransomware''' is a type of [[malware|malware]] (malicious software) that limits users from accessing all or part of their computer unless a ransom is paid, often in the form of cryptocurrency such as Bitcoin.<br />
Some forms of ransomware lock a computer’s screen and display a demand for payment. [1] The victim’s files remain untouched, however, and this form of ransomware can sometimes be removed without paying the attacker. [2] Newer ransomware called ''cryptoviral extortion'' encrypts a user’s files. This more advanced form of malware renders files inaccessible even if the malware is removed. [3] Thus, the victim must pay the attacker for the decryption key in order to regain access to his files. <br />
<br />
== History of encrypting ransomware ==<br />
In 1989, Joseph Popp created the first known encrypting malware called the “AIDS Trojan” which was distributed on floppy disks via snail mail. This malware was limited in its design. The AIDS Trojan only encrypted the names of files and not the files themselves. Furthermore, the trojan used symmetric encryption (where the same key is used to encrypt and decrypt files) and the decryption key could be extracted from the code of the trojan. This made it unnecessary to pay ransom to reverse the effects of the trojan. [4]<br />
<br />
The idea of using asymmetric or public key [[encryption|encryption]] was introduced by researchers Adam L. Young and Moti Yung 1996 at an IEEE symposium. [5] Actual ransomware using this scheme became increasingly common after 2005. [6] In asymmetric encryption, a different key is used for encryption (the public key) and for decryption (the private key). The public key is used to encrypt the victim’s files while the private key is known only to the creators of the ransomware. The ransomware’s effects cannot be overcome without paying for the private key. [5]<br />
<br />
== Mechanism of encryption ==<br />
More recent malware such as CryptoLocker and WannaCry use a hybrid model combining asymmetric and symmetric encryption to capitalize on the strengths of both schemes. Using asymmetric keys allows the attackers to keep the private key secret. Symmetric keys allow encryption to occur more efficiently, enabling victim files to rapidly be encrypted. [7] <br />
# The attacker creates a key pair. The public key is placed in the code of the malware. The private key is kept secret and known only to the attacker. <br />
# When the malware is run on the victim’s computer, a random symmetric key is created locally and used to encrypt all of the victim’s files. This symmetric key is then itself encrypted by the public key in the malware and generates an asymmetric ciphertext. A message is sent to the victim with the asymmetric ciphertext and information on how to pay the ransom. The victim then sends both payment and the asymmetric ciphertext to the attacker. <br />
# When the ransom is received, the attacker uses the private key to decrypt the asymmetric ciphertext to reveal the victim’s symmetric key. The symmetric key is sent to the victim.<br />
# The victim then uses the symmetric key to decrypt the files. [8]<br />
<br />
== How ransomware infects computers == <br />
* Email – Emails may contain infected attachments or links to infected websites.<br />
* Compromised Websites – Websites may have exploit kits which can infect a computer without any clicking. These websites contain malicious code that take advantage of vulnerabilities in software or browsers. If such a vulnerability exists (e.g., software patches that are not up to date), the exploit kit uses the vulnerability to download ransomware. [9] [10] [11] Even visiting reputable websites can expose a victim to exploit kits. For example, in 2016, malicious advertisements containing exploit kits affected The New York Times, the BBC, MSN, and AOL. [12]<br />
* Wormlike behavior – Certain ransomware uses a computer’s software vulnerabilities to spread throughout networks. For example, WannaCry and Petya spread via EternalBlue MS17-010. It exploited a vulnerability in Microsoft Windows operating system, specifically the network file sharing protocol Server Message Block 1.0 (SMB). This vulnerability allowed “applications on a computer to read and write to file and request services”, and the ransomware was distributed throughout local networks without any user action. Computers without the appropriate security patch were then infected and could spread the ransomware further. [13] [14] <br />
<br />
== Ransomware targets healthcare == <br />
The healthcare industry is a prime target for cyberattacks such as ransomware for many reasons. <br />
=== Ease of attack ===<br />
Hospital networks are quickly expanding to meet government requirements such as increased electronic health record information exchange. [15] However, the cybersecurity of these networks is not as robust as that of other industries like finance. The primary focus of healthcare IT systems is often patient care and rapid accessibility rather than cybersecurity [16][17]. In fact, it is estimated that less than 5% of hospital IT budgets are spent on security and there are often long delays before security patches are implemented [18] [19]. Hospitals are thus seen as “soft targets.”<br />
=== Hospitals are more likely to pay ransom ===<br />
Hospitals depend on rapid access to data in order to provide patient care. Ransomware attacks can result in compromised delivery of healthcare and lawsuits if patients suffer harm from delayed or cancelled appointments and procedures. This makes hospitals more likely to pay ransom to quickly regain access to critical and often irreplaceable data. [6] [20] <br />
=== Healthcare data is valuable ===<br />
Health data includes sensitive information such as social security numbers, insurance details, addresses, etc. Attackers can use this extensive information to perpetrate medical fraud and identity theft, access financial information, and extort money by threatening to reveal a victim’s personal history (15). The variety of possible criminal uses makes healthcare data valuable. A single patient’s health record can be sold on the black market for between $1.50 and $10. [21] This is up to ten times more valuable than a person’s credit card details. [22] <br />
However, this black market price of a single complete health record has actually fallen in 2016 due to the growing supply of breached healthcare data. (In 2015, the Department of Health and Human Services’ Office for Civil Rights estimates 113 million healthcare records were breached. [23] Before these large breaches, in 2012, a single record used to fetch $50 to $60 dollars. This fall in health record price has actually encouraged the number of ransomware attacks as cybercriminals need to steal more health records (or extort ransom) in order to achieve the same profit. [21]<br />
<br />
<br />
The threat of ransomware to healthcare organizations is only expected to grow. The Verizon DBIR 2017 report showed that healthcare was the number two industry target for ransomware, behind Public Administration and ahead of Financial Services. In 2017, 72% of all malware incidents in the healthcare sector involved ransomware. [16] And the 2017 Experian Data Breach Industry Forecast report predicts that healthcare organizations will become the industry most heavily targeted by cybercriminals. [24] <br />
<br />
== Notable ransomware attacks on healthcare systems == <br />
<br />
* February 5, 2016 – Hollywood Presbyterian Medical Center, a 434-bed acute care hospital, experienced a Locky ransomware attack and lost access to its computer systems. This caused severe disruptions and hospital staff had to rely on pen-and-paper. The systems were restored after the Hollywood Presbyterian paid the attackers $17,000 in bitcoin ransom. [25]<br />
<br />
* March 28, 2016 – 10 hospitals and 250 outpatient centers in the MedStar network, Washington DC were affected by ransomware, forcing a temporary shutdown of electronic health and email systems. [26]<br />
<br />
* March 2016 – Methodist Hospital in Henderson, KY was affected by ransomware and declared an “internal state of emergency” for five days until data was restored from backups. [6] [27]<br />
<br />
* March 18, 2016 – Chino Valley Medical Center and Desert Valley Hospital in Southern CA were attacked by ransomware. Affected computers and some hospital servers were temporarily taken offline in order to prevent further spread. Patient health records were not compromised but the attack caused significant disruption. [28]<br />
<br />
* 2017 – UK National Health Service – The WannaCry ransomware variant affected 48 UK NHS hospital trusts. Doctor’s offices were shut down, affected hospitals diverted patients to other facilities, and non-critical appointments and surgeries were canceled. [29]<br />
<br />
* May 2017 – The first reports emerged of ransomware compromising medical devices in US hospitals. These attacks affected Bayer Medrad Windows-based devices [30]<br />
<br />
<br />
<br />
== WannaCry: Attack on the NHS – a primary care practice perspective ==<br />
--[[User:Samsun|Samsun]] ([[User talk:Samsun|talk]]) 22:51, 27 October 2020 (UTC)<br />
<br />
On May 12th, 2017, global ransomware called WannaCry locked out over 230,000 computers in at least 150 countries, including the NHS in the U.K.[1]. Although the NHS was not the primary target, this cyber attack directly affected 34 percent of the hospital trusts and 8 percent of primary care practices, causing significant disruption to the services due to the cancellation of thousands of patient visits and operations. During this time, primary care practices, although not directly affected, had to shut down the computer system to prevent any further spread. So, the practices had to resort to manual processes of recording notes, reporting test results, and referrals, not to mention managing the disgruntled patients, the subsequent backlog it created, especially catching up with the sudden influx of test results and letters and the time spend input all of the handwritten notes into the Electronic Health Record (EHR). <br />
<br />
It was reported that this ransomware, which exploited a known weakness in computers running Windows, could have been prevented had security updates from Microsoft were applied promptly, a robust firewall been set up on the NHS broadband network, and legacy platforms like Windows XP were updated to newer operating systems. No ransom was reportedly paid, and the malicious software was halted in the evening of the same day when an independent cybersecurity researcher inadvertently found and activated an inbuilt “kill-switch”[2]. Although a patch was released by Microsoft the following day, some primary care practices had to wait almost seven days before it was applied to their system, causing further disruption of services.<br />
<br />
A report published by the National Audit Office[3] highlighted that though the Department of Health had a plan to deal with such a situation, this had not been tested at a local level. The NHS had also not rehearsed for such a cyberattack, which led to the initial confusion as to who would lead the response to the attack. Though the need for maintaining emergency care was identified as a priority, there was a lack of clear and timely communication with all the relevant stakeholders. It is estimated that the WannaCry ransomware attack cost the NHS £92 million, which included £20 million due to lost outputs from canceled appointment and operations, and a further £72 million to deal with the aftermath related to the recovery of the data and the restoration of the systems[4].<br />
<br />
NHS England, in its report[1], acknowledged the inadequacies within the system and highlighted plans to strengthen NHS' cyber-security, based on the key lessons that were learned from the incident. These included developing a response plan in the event of a cyberattack and establishing the resources' roles and responsibilities. It also emphasized the need to have regular monitoring of all software, ensure that they are up to date, any critical patches are applied promptly, and ensure essential and timely communication with all relevant stakeholders. Above all, it emphasized leaders, organizations, and their staff's responsibility in taking cyber threats seriously, understanding the associated risks, and proactively taking measures to mitigate these risks.<br />
<br />
NHS Digital produced a Data Security Standards guide, which layouts ten standards to mitigate the risk of a future cyberattack, addressing issues around the three main entities – people, process, and technology. The fundamentals of it being:<br />
'''People:''' ensure staff is equipped to handle information respectfully and safely, according to the Caldicott Principles.<br />
'''Process:''' ensure the organization proactively prevents data security breaches and responds appropriately to incidents or near misses.<br />
'''Technology:''' ensure technology is secure and up-to-date.<br />
<br />
Also, the Department of Health and Social care reported in 2018 that the NHS would spend £150 million to bolster its cybersecurity to prevent a further cyberattack like the WannaCry[5]. A subsequent report by Comparitech[6], a company that provides consumers privacy information, tools, and comparisons, underlines a relative reduction in the number of recent cyberattacks in the U.K., which according to them, could be a result of the “effective” measures implemented to thwart another cyberattack, with increased spending on measures to improve cybersecurity, practices, and training for their staff.<br />
<br />
== Impact of ransomware attacks on health systems == <br />
Ransomware attacks in healthcare systems are extremely damaging. First they endanger patient safety by preventing access to critical information in the medical record – e.g., allergies, medication lists, lab results, treatment plans, etc. Without this information, medical care can be rendered incorrectly or delayed. [20]<br />
<br />
'''Legal ramifications for hospitals'''<br />
<br />
As a result of the attack, a hospital may be subject to government action under the HIPAA Security Rule. [20] [31] A ransomware attack is considered a “security incident” defined as “attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.” Due to the increasing frequency of ransomware attacks, the U.S. Department of Health and Human Services released a fact sheet giving detailed guidance regarding ransomware and requirements such as reporting of security incidents. [32] This fact sheet clarified that a ransomware infection is considered a HIPAA breach, defined as “… the acquisition, access, use, or disclosure of PHI in a manner not permitted under the [HIPAA Privacy Rule] which comprises the security or privacy of the PHI.” [33] Specifically, ransomware encryption of protected health information is a breach since the data “was acquired (i.e., unauthorized individuals have taken possession or control of the information), and thus is a ‘disclosure’ not permitted under the HIPAA Privacy Rule.” [32]<br />
<br />
== How to prevent ransomware infections ==<br />
* Keep software updated with patches and security updates – this leaves fewer vulnerabilities for malware to exploit<br />
* Run antivirus software and keep it up-to-date <br />
* Do not click pop-up windows or links in suspicious emails. <br />
* Back up data so that if a system becomes infected, the data can be restored. <br />
* Have an organizational security plan<br />
# Set a companywide schedule for computers to get the latest software updates<br />
# Educate employees on security awareness and data hygiene [34]<br />
<br />
<br />
<br />
== References ==<br />
<br />
# Ransomware. Trend Micro. Published 2017. https://www.trendmicro.com/vinfo/us/security/definition/Ransomware.<br />
# Geier E. How to rescue your PC from ransomware. PCWorld. Published April 3, 2017. https://www.pcworld.com/article/2084002/security/how-to-rescue-your-pc-from-ransomware.html<br />
# Nagpal B, Wadhwa V. (2016) Cryptoviral Extortion: Evolution, Scenarios, and Analysis. In: Lobiyal D, Mohapatra D, Nagar A, Sahoo M. (eds) Proceedings of the International Conference on Signal, Networks, Computing, and Systems. Lecture Notes in Electrical Engineering, vol 396. Springer, New Delhi<br />
# Wilding E., Skulason F. (eds) Virus bulletin. The authoritative international publication on computer virus prevention, recognition, and removal. Published Jan 1990. https://www.virusbulletin.com/uploads/pdf/magazine/1990/199001.pdf <br />
# Young, A, Yung M. (1996). Cryptovirology: extortion-based security threats and countermeasures. IEEE Symposium on Security and Privacy. pp. 129–140. ISBN 0-8186-7417-2. doi:10.1109/SECPRI.1996.502676<br />
# Zetter Kim. Why hospitals are the perfect targets for ransomware. Wired. Published Mar. 30, 2016. https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/<br />
# Kappuswamy P, Al-Khalidi SQY. Hybrid encryption/decryption technique using new public key and symmetric key algorithm. MIS Review Vol. 19, No. 2, March (2014), pp. 1-13 DOI: 10.6131/MISR.2014.1902.01 https://pdfs.semanticscholar.org/87ff/ea85fbf52e22e4808e1fcc9e40ead4ff7738.pdf<br />
# Can files locked by WannaCry be decrypted: a technical analysis. Symantec. https://medium.com/threat-intel/wannacry-ransomware-decryption-821c7e3f0a2b<br />
# Crowe J. Ransomware FAQ: how ransomware infects your computer. Barkly. https://blog.barkly.com/how-ransomware-infects-computers#infection Published Sept 2016. <br />
# How ransomware infects computers. McAfee. https://www.mcafee.com/us/security-awareness/articles/how-ransomware-infects-computers.aspx<br />
# Ransomware FAQ. Windows Defender Security Intelligence. https://www.microsoft.com/en-us/wdsi/threats/ransomware<br />
# Goodin, D. Big-name sites hit by rash of malicious ads spreading crypto ransomware. Ars Technica. Published Mar 15, 2016. https://arstechnica.com/information-technology/2016/03/big-name-sites-hit-by-rash-of-malicious-ads-spreading-crypto-ransomware/<br />
# Grobman, S. WannaCry: the old worms and the new. McAfee. https://securingtomorrow.mcafee.com/executive-perspectives/wannacry-old-worms-new/ Published May 12, 2017.<br />
# Burgess, M. Everything you need to know about EternalBlue – the NSA exploit linked to Petya. Wired. Published June 28, 2017. https://www.wired.co.uk/article/what-is-eternal-blue-exploit-vulnerability-patch<br />
# Kruse CS, Frederick B, Jacobson T, Monticone DK. 2017. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technology and Health Care 25 (2017) 1-10. <br />
# 2017 Data breach investigations report. 10th ed. Verizon. http://www.verizonenterprise.com/verizon-insights-lab/dbir/2017/<br />
# Bai G, Jiang J, Flasher R. Hospital risk of data breaches. JAMA Intern Med. 2017;177(6):878-880. doi:10.1001/jamainternmed.2017.0336<br />
# AHC Media LLC. Hackers target hospitals with “ransomware”. ED LEGAL LETT. 2016 Apr; 27(4): also available https://www.ahcmedia.com/articles/137468-hackers-target-hospitals-with-ransomware<br />
# Newman, LH. The ransomware meltdown experts warned about is here. Wired. Published May 12, 2017. https://www.wired.com/2017/05/ransomware-meltdown-experts-warned/<br />
# Cohen IG, Hoffman S, Adashi EY. Your money or your patient’s life? Ransomware and electronic health records. Ann Intern Med. 2017;167(8):587-588<br />
# Increase in ransomware and cyberattacks linked to fall in price of health data. HIPAA Journal. Dec 2016. www.hipaajournal.com/increase-in-ransomware-and-cyberattacks-linked-to-fall-in-price-of-health-data-8622.<br />
# Chinthapalli K. The hackers holding hospitals to ransom. BMJ 2017;357:j2214<br />
# 2015: the year of the healthcare data breach. HIPAA Journal. Published Dec. 29, 2015. https://www.hipaajournal.com/2015-the-year-of-the-healthcare-data-breach-8239/<br />
# Fourth annual 2017 Data Breach industry forecast. Experian. https://www.experian.com/assets/data-breach/white-papers/2017-experian-data-breach-industry-forecast.pdf<br />
# Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Published Feb 18, 2016. http://www.latimes.com/business/technology/la-me-ln-hollywood-hospital-bitcoin-20160217-story.html<br />
# Virus forces shutdown of Medstar Health System’s 10-hospital computer network. HIPAA Journal. Published Mar. 29, 2016. https://www.hipaajournal.com/virus-forces-shutdown-medstar-health-systems-10-hospital-computer-network-3372/<br />
# Monegain B. Methodist Hospital recovering from five day ransomware attack, claims it did not pay up. HealthcareITNews. Published Mar. 22, 2016. http://www.healthcareitnews.com/news/methodist-hospital-recovering-five-day-ransomware-attack-claims-it-did-not-pay<br />
# Two more Californian hospital ransomware attacks reported. HIPAA Journal. Published Mar. 23, 2016. https://www.hipaajournal.com/two-more-californian-hospital-ransomware-attacks-reported-3368/<br />
# Erlanger S, Bilefsky D, Chan S. U.K. Health Service ignored warnings for months. The New York Times. Published May 12, 2017. https://www.nytimes.com/2017/05/12/world/europe/nhs-cyberattack-warnings.html<br />
# Fox-Brewster, T. Medical devices hit by ransomware for the first time in US hospitals. Forbes. Published May 17, 2017. https://www.forbes.com/sites/thomasbrewster/2017/05/17/wannacry-ransomware-hit-real-medical-devices/#75b8806b425c<br />
# Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-91 (1996).<br />
# Department of Health and Human Services. Fact Sheet: Ransomware and HIPAA. Accessed at www.hhs.gov/sites/default/files/RansomwareFactSheet.pdf on 26 May 2017.<br />
# 45 C.F.R. § 164.302-.318 (2016).<br />
# Chen, BX. How to protect yourself from ransomware attacks. The New York Times. Published May 15, 2017. https://www.nytimes.com/2017/05/15/technology/personaltech/heres-how-to-protect-yourself-from-ransomware-attacks.html<br />
<br />
[1] W. Smart and S. House, “Lessons learned review of the WannaCry Ransomware Cyber Attack,” p. 42.<br />
[2] N. K. O. S. in S. Francisco, “‘Accidental hero’ halts ransomware attack and warns: this is not over,” The Guardian, May 13, 2017.<br />
[3] “Investigation-WannaCry-cyber-attack-and-the-NHS.pdf.” Accessed: Sep. 02, 2020. [Online]. Available: https://www.nao.org.uk/wp-content/uploads/2017/10/Investigation-WannaCry-cyber-attack-and-the-NHS.pdf.<br />
[4] “Department of Health and Social Care puts cost of WannaCry to NHS at £92m,” Digital Health, Oct. 12, 2018. https://www.digitalhealth.net/2018/10/dhsc-puts-cost-wannacry-nhs-92m/ (accessed Sep. 02, 2020).<br />
[5] “NHS to spend £150m on cyber security to bolster defences after WannaCry attack.” https://www.independent.co.uk/news/health/cyber-attacks-nhs-wannacry-security-investment-microsoft-a8327091.html (accessed Sep. 02, 2020).<br />
[6] “Ransomware Attacks on Hospitals & Healthcare Cost $157m since 2016,” Comparitech, Feb. 11, 2020. https://www.comparitech.com/blog/information-security/ransomware-attacks-hospitals-data/ (accessed Sep. 01, 2020).<br />
<br />
<br />
<br />
Submitted by Abigail Huang<br />
[[Category:BMI512-FALL-17]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/RansomwareRansomware2020-10-27T22:56:20Z<p>Samsun: /* WannaCry: Attack on the NHS – a primary care practice perspective */</p>
<hr />
<div>'''Ransomware''' is a type of [[malware|malware]] (malicious software) that limits users from accessing all or part of their computer unless a ransom is paid, often in the form of cryptocurrency such as Bitcoin.<br />
Some forms of ransomware lock a computer’s screen and display a demand for payment. [1] The victim’s files remain untouched, however, and this form of ransomware can sometimes be removed without paying the attacker. [2] Newer ransomware called ''cryptoviral extortion'' encrypts a user’s files. This more advanced form of malware renders files inaccessible even if the malware is removed. [3] Thus, the victim must pay the attacker for the decryption key in order to regain access to his files. <br />
<br />
== History of encrypting ransomware ==<br />
In 1989, Joseph Popp created the first known encrypting malware called the “AIDS Trojan” which was distributed on floppy disks via snail mail. This malware was limited in its design. The AIDS Trojan only encrypted the names of files and not the files themselves. Furthermore, the trojan used symmetric encryption (where the same key is used to encrypt and decrypt files) and the decryption key could be extracted from the code of the trojan. This made it unnecessary to pay ransom to reverse the effects of the trojan. [4]<br />
<br />
The idea of using asymmetric or public key [[encryption|encryption]] was introduced by researchers Adam L. Young and Moti Yung 1996 at an IEEE symposium. [5] Actual ransomware using this scheme became increasingly common after 2005. [6] In asymmetric encryption, a different key is used for encryption (the public key) and for decryption (the private key). The public key is used to encrypt the victim’s files while the private key is known only to the creators of the ransomware. The ransomware’s effects cannot be overcome without paying for the private key. [5]<br />
<br />
== Mechanism of encryption ==<br />
More recent malware such as CryptoLocker and WannaCry use a hybrid model combining asymmetric and symmetric encryption to capitalize on the strengths of both schemes. Using asymmetric keys allows the attackers to keep the private key secret. Symmetric keys allow encryption to occur more efficiently, enabling victim files to rapidly be encrypted. [7] <br />
# The attacker creates a key pair. The public key is placed in the code of the malware. The private key is kept secret and known only to the attacker. <br />
# When the malware is run on the victim’s computer, a random symmetric key is created locally and used to encrypt all of the victim’s files. This symmetric key is then itself encrypted by the public key in the malware and generates an asymmetric ciphertext. A message is sent to the victim with the asymmetric ciphertext and information on how to pay the ransom. The victim then sends both payment and the asymmetric ciphertext to the attacker. <br />
# When the ransom is received, the attacker uses the private key to decrypt the asymmetric ciphertext to reveal the victim’s symmetric key. The symmetric key is sent to the victim.<br />
# The victim then uses the symmetric key to decrypt the files. [8]<br />
<br />
== How ransomware infects computers == <br />
* Email – Emails may contain infected attachments or links to infected websites.<br />
* Compromised Websites – Websites may have exploit kits which can infect a computer without any clicking. These websites contain malicious code that take advantage of vulnerabilities in software or browsers. If such a vulnerability exists (e.g., software patches that are not up to date), the exploit kit uses the vulnerability to download ransomware. [9] [10] [11] Even visiting reputable websites can expose a victim to exploit kits. For example, in 2016, malicious advertisements containing exploit kits affected The New York Times, the BBC, MSN, and AOL. [12]<br />
* Wormlike behavior – Certain ransomware uses a computer’s software vulnerabilities to spread throughout networks. For example, WannaCry and Petya spread via EternalBlue MS17-010. It exploited a vulnerability in Microsoft Windows operating system, specifically the network file sharing protocol Server Message Block 1.0 (SMB). This vulnerability allowed “applications on a computer to read and write to file and request services”, and the ransomware was distributed throughout local networks without any user action. Computers without the appropriate security patch were then infected and could spread the ransomware further. [13] [14] <br />
<br />
== Ransomware targets healthcare == <br />
The healthcare industry is a prime target for cyberattacks such as ransomware for many reasons. <br />
=== Ease of attack ===<br />
Hospital networks are quickly expanding to meet government requirements such as increased electronic health record information exchange. [15] However, the cybersecurity of these networks is not as robust as that of other industries like finance. The primary focus of healthcare IT systems is often patient care and rapid accessibility rather than cybersecurity [16][17]. In fact, it is estimated that less than 5% of hospital IT budgets are spent on security and there are often long delays before security patches are implemented [18] [19]. Hospitals are thus seen as “soft targets.”<br />
=== Hospitals are more likely to pay ransom ===<br />
Hospitals depend on rapid access to data in order to provide patient care. Ransomware attacks can result in compromised delivery of healthcare and lawsuits if patients suffer harm from delayed or cancelled appointments and procedures. This makes hospitals more likely to pay ransom to quickly regain access to critical and often irreplaceable data. [6] [20] <br />
=== Healthcare data is valuable ===<br />
Health data includes sensitive information such as social security numbers, insurance details, addresses, etc. Attackers can use this extensive information to perpetrate medical fraud and identity theft, access financial information, and extort money by threatening to reveal a victim’s personal history (15). The variety of possible criminal uses makes healthcare data valuable. A single patient’s health record can be sold on the black market for between $1.50 and $10. [21] This is up to ten times more valuable than a person’s credit card details. [22] <br />
However, this black market price of a single complete health record has actually fallen in 2016 due to the growing supply of breached healthcare data. (In 2015, the Department of Health and Human Services’ Office for Civil Rights estimates 113 million healthcare records were breached. [23] Before these large breaches, in 2012, a single record used to fetch $50 to $60 dollars. This fall in health record price has actually encouraged the number of ransomware attacks as cybercriminals need to steal more health records (or extort ransom) in order to achieve the same profit. [21]<br />
<br />
<br />
The threat of ransomware to healthcare organizations is only expected to grow. The Verizon DBIR 2017 report showed that healthcare was the number two industry target for ransomware, behind Public Administration and ahead of Financial Services. In 2017, 72% of all malware incidents in the healthcare sector involved ransomware. [16] And the 2017 Experian Data Breach Industry Forecast report predicts that healthcare organizations will become the industry most heavily targeted by cybercriminals. [24] <br />
<br />
== Notable ransomware attacks on healthcare systems == <br />
<br />
* February 5, 2016 – Hollywood Presbyterian Medical Center, a 434-bed acute care hospital, experienced a Locky ransomware attack and lost access to its computer systems. This caused severe disruptions and hospital staff had to rely on pen-and-paper. The systems were restored after the Hollywood Presbyterian paid the attackers $17,000 in bitcoin ransom. [25]<br />
<br />
* March 28, 2016 – 10 hospitals and 250 outpatient centers in the MedStar network, Washington DC were affected by ransomware, forcing a temporary shutdown of electronic health and email systems. [26]<br />
<br />
* March 2016 – Methodist Hospital in Henderson, KY was affected by ransomware and declared an “internal state of emergency” for five days until data was restored from backups. [6] [27]<br />
<br />
* March 18, 2016 – Chino Valley Medical Center and Desert Valley Hospital in Southern CA were attacked by ransomware. Affected computers and some hospital servers were temporarily taken offline in order to prevent further spread. Patient health records were not compromised but the attack caused significant disruption. [28]<br />
<br />
* 2017 – UK National Health Service – The WannaCry ransomware variant affected 48 UK NHS hospital trusts. Doctor’s offices were shut down, affected hospitals diverted patients to other facilities, and non-critical appointments and surgeries were canceled. [29]<br />
<br />
* May 2017 – The first reports emerged of ransomware compromising medical devices in US hospitals. These attacks affected Bayer Medrad Windows-based devices [30]<br />
<br />
<br />
<br />
== WannaCry: Attack on the NHS – a primary care practice perspective ==<br />
--[[User:Samsun|Samsun]] ([[User talk:Samsun|talk]]) 22:51, 27 October 2020 (UTC)<br />
<br />
On May 12th, 2017, global ransomware called WannaCry locked out over 230,000 computers in at least 150 countries, including the NHS in the U.K.[1]. Although the NHS was not the primary target, this cyber attack directly affected 34 percent of the hospital trusts and 8 percent of primary care practices, causing significant disruption to the services due to the cancellation of thousands of patient visits and operations. During this time, primary care practices, although not directly affected, had to shut down the computer system to prevent any further spread. So, the practices had to resort to manual processes of recording notes, reporting test results, and referrals, not to mention managing the disgruntled patients, the subsequent backlog it created, especially catching up with the sudden influx of test results and letters and the time spend input all of the handwritten notes into the Electronic Health Record (EHR). <br />
<br />
It was reported that this ransomware, which exploited a known weakness in computers running Windows, could have been prevented had security updates from Microsoft were applied promptly, a robust firewall been set up on the NHS broadband network, and legacy platforms like Windows XP were updated to newer operating systems. No ransom was reportedly paid, and the malicious software was halted in the evening of the same day when an independent cybersecurity researcher inadvertently found and activated an inbuilt “kill-switch”[2]. Although a patch was released by Microsoft the following day, some primary care practices had to wait almost seven days before it was applied to their system, causing further disruption of services.<br />
<br />
A report published by the National Audit Office[3] highlighted that though the Department of Health had a plan to deal with such a situation, this had not been tested at a local level. The NHS had also not rehearsed for such a cyberattack, which led to the initial confusion as to who would lead the response to the attack. Though the need for maintaining emergency care was identified as a priority, there was a lack of clear and timely communication with all the relevant stakeholders. It is estimated that the WannaCry ransomware attack cost the NHS £92 million, which included £20 million due to lost outputs from canceled appointment and operations, and a further £72 million to deal with the aftermath related to the recovery of the data and the restoration of the systems[4].<br />
<br />
NHS England, in its report[1], acknowledged the inadequacies within the system and highlighted plans to strengthen NHS' cyber-security, based on the key lessons that were learned from the incident. These included developing a response plan in the event of a cyberattack and establishing the resources' roles and responsibilities. It also emphasized the need to have regular monitoring of all software, ensure that they are up to date, any critical patches are applied promptly, and ensure essential and timely communication with all relevant stakeholders. Above all, it emphasized leaders, organizations, and their staff's responsibility in taking cyber threats seriously, understanding the associated risks, and proactively taking measures to mitigate these risks.<br />
<br />
NHS Digital produced a Data Security Standards guide, which layouts ten standards to mitigate the risk of a future cyberattack, addressing issues around the three main entities – people, process, and technology. The fundamentals of it being:<br />
'''People:''' ensure staff is equipped to handle information respectfully and safely, according to the Caldicott Principles.<br />
'''Process:''' ensure the organization proactively prevents data security breaches and responds appropriately to incidents or near misses.<br />
'''Technology:''' ensure technology is secure and up-to-date.<br />
<br />
Also, the Department of Health and Social care reported in 2018 that the NHS would spend £150 million to bolster its cybersecurity to prevent a further cyberattack like the WannaCry[5]. A subsequent report by Comparitech[6], a company that provides consumers privacy information, tools, and comparisons, underlines a relative reduction in the number of recent cyberattacks in the U.K., which according to them, could be a result of the “effective” measures implemented to thwart another cyberattack, with increased spending on measures to improve cybersecurity, practices, and training for their staff.<br />
<br />
== Impact of ransomware attacks on health systems == <br />
Ransomware attacks in healthcare systems are extremely damaging. First they endanger patient safety by preventing access to critical information in the medical record – e.g., allergies, medication lists, lab results, treatment plans, etc. Without this information, medical care can be rendered incorrectly or delayed. [20]<br />
<br />
'''Legal ramifications for hospitals'''<br />
<br />
As a result of the attack, a hospital may be subject to government action under the HIPAA Security Rule. [20] [31] A ransomware attack is considered a “security incident” defined as “attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.” Due to the increasing frequency of ransomware attacks, the U.S. Department of Health and Human Services released a fact sheet giving detailed guidance regarding ransomware and requirements such as reporting of security incidents. [32] This fact sheet clarified that a ransomware infection is considered a HIPAA breach, defined as “… the acquisition, access, use, or disclosure of PHI in a manner not permitted under the [HIPAA Privacy Rule] which comprises the security or privacy of the PHI.” [33] Specifically, ransomware encryption of protected health information is a breach since the data “was acquired (i.e., unauthorized individuals have taken possession or control of the information), and thus is a ‘disclosure’ not permitted under the HIPAA Privacy Rule.” [32]<br />
<br />
== How to prevent ransomware infections ==<br />
* Keep software updated with patches and security updates – this leaves fewer vulnerabilities for malware to exploit<br />
* Run antivirus software and keep it up-to-date <br />
* Do not click pop-up windows or links in suspicious emails. <br />
* Back up data so that if a system becomes infected, the data can be restored. <br />
* Have an organizational security plan<br />
# Set a companywide schedule for computers to get the latest software updates<br />
# Educate employees on security awareness and data hygiene [34]<br />
<br />
<br />
<br />
== References ==<br />
<br />
# Ransomware. Trend Micro. Published 2017. https://www.trendmicro.com/vinfo/us/security/definition/Ransomware.<br />
# Geier E. How to rescue your PC from ransomware. PCWorld. Published April 3, 2017. https://www.pcworld.com/article/2084002/security/how-to-rescue-your-pc-from-ransomware.html<br />
# Nagpal B, Wadhwa V. (2016) Cryptoviral Extortion: Evolution, Scenarios, and Analysis. In: Lobiyal D, Mohapatra D, Nagar A, Sahoo M. (eds) Proceedings of the International Conference on Signal, Networks, Computing, and Systems. Lecture Notes in Electrical Engineering, vol 396. Springer, New Delhi<br />
# Wilding E., Skulason F. (eds) Virus bulletin. The authoritative international publication on computer virus prevention, recognition, and removal. Published Jan 1990. https://www.virusbulletin.com/uploads/pdf/magazine/1990/199001.pdf <br />
# Young, A, Yung M. (1996). Cryptovirology: extortion-based security threats and countermeasures. IEEE Symposium on Security and Privacy. pp. 129–140. ISBN 0-8186-7417-2. doi:10.1109/SECPRI.1996.502676<br />
# Zetter Kim. Why hospitals are the perfect targets for ransomware. Wired. Published Mar. 30, 2016. https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/<br />
# Kappuswamy P, Al-Khalidi SQY. Hybrid encryption/decryption technique using new public key and symmetric key algorithm. MIS Review Vol. 19, No. 2, March (2014), pp. 1-13 DOI: 10.6131/MISR.2014.1902.01 https://pdfs.semanticscholar.org/87ff/ea85fbf52e22e4808e1fcc9e40ead4ff7738.pdf<br />
# Can files locked by WannaCry be decrypted: a technical analysis. Symantec. https://medium.com/threat-intel/wannacry-ransomware-decryption-821c7e3f0a2b<br />
# Crowe J. Ransomware FAQ: how ransomware infects your computer. Barkly. https://blog.barkly.com/how-ransomware-infects-computers#infection Published Sept 2016. <br />
# How ransomware infects computers. McAfee. https://www.mcafee.com/us/security-awareness/articles/how-ransomware-infects-computers.aspx<br />
# Ransomware FAQ. Windows Defender Security Intelligence. https://www.microsoft.com/en-us/wdsi/threats/ransomware<br />
# Goodin, D. Big-name sites hit by rash of malicious ads spreading crypto ransomware. Ars Technica. Published Mar 15, 2016. https://arstechnica.com/information-technology/2016/03/big-name-sites-hit-by-rash-of-malicious-ads-spreading-crypto-ransomware/<br />
# Grobman, S. WannaCry: the old worms and the new. McAfee. https://securingtomorrow.mcafee.com/executive-perspectives/wannacry-old-worms-new/ Published May 12, 2017.<br />
# Burgess, M. Everything you need to know about EternalBlue – the NSA exploit linked to Petya. Wired. Published June 28, 2017. https://www.wired.co.uk/article/what-is-eternal-blue-exploit-vulnerability-patch<br />
# Kruse CS, Frederick B, Jacobson T, Monticone DK. 2017. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technology and Health Care 25 (2017) 1-10. <br />
# 2017 Data breach investigations report. 10th ed. Verizon. http://www.verizonenterprise.com/verizon-insights-lab/dbir/2017/<br />
# Bai G, Jiang J, Flasher R. Hospital risk of data breaches. JAMA Intern Med. 2017;177(6):878-880. doi:10.1001/jamainternmed.2017.0336<br />
# AHC Media LLC. Hackers target hospitals with “ransomware”. ED LEGAL LETT. 2016 Apr; 27(4): also available https://www.ahcmedia.com/articles/137468-hackers-target-hospitals-with-ransomware<br />
# Newman, LH. The ransomware meltdown experts warned about is here. Wired. Published May 12, 2017. https://www.wired.com/2017/05/ransomware-meltdown-experts-warned/<br />
# Cohen IG, Hoffman S, Adashi EY. Your money or your patient’s life? Ransomware and electronic health records. Ann Intern Med. 2017;167(8):587-588<br />
# Increase in ransomware and cyberattacks linked to fall in price of health data. HIPAA Journal. Dec 2016. www.hipaajournal.com/increase-in-ransomware-and-cyberattacks-linked-to-fall-in-price-of-health-data-8622.<br />
# Chinthapalli K. The hackers holding hospitals to ransom. BMJ 2017;357:j2214<br />
# 2015: the year of the healthcare data breach. HIPAA Journal. Published Dec. 29, 2015. https://www.hipaajournal.com/2015-the-year-of-the-healthcare-data-breach-8239/<br />
# Fourth annual 2017 Data Breach industry forecast. Experian. https://www.experian.com/assets/data-breach/white-papers/2017-experian-data-breach-industry-forecast.pdf<br />
# Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Published Feb 18, 2016. http://www.latimes.com/business/technology/la-me-ln-hollywood-hospital-bitcoin-20160217-story.html<br />
# Virus forces shutdown of Medstar Health System’s 10-hospital computer network. HIPAA Journal. Published Mar. 29, 2016. https://www.hipaajournal.com/virus-forces-shutdown-medstar-health-systems-10-hospital-computer-network-3372/<br />
# Monegain B. Methodist Hospital recovering from five day ransomware attack, claims it did not pay up. HealthcareITNews. Published Mar. 22, 2016. http://www.healthcareitnews.com/news/methodist-hospital-recovering-five-day-ransomware-attack-claims-it-did-not-pay<br />
# Two more Californian hospital ransomware attacks reported. HIPAA Journal. Published Mar. 23, 2016. https://www.hipaajournal.com/two-more-californian-hospital-ransomware-attacks-reported-3368/<br />
# Erlanger S, Bilefsky D, Chan S. U.K. Health Service ignored warnings for months. The New York Times. Published May 12, 2017. https://www.nytimes.com/2017/05/12/world/europe/nhs-cyberattack-warnings.html<br />
# Fox-Brewster, T. Medical devices hit by ransomware for the first time in US hospitals. Forbes. Published May 17, 2017. https://www.forbes.com/sites/thomasbrewster/2017/05/17/wannacry-ransomware-hit-real-medical-devices/#75b8806b425c<br />
# Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-91 (1996).<br />
# Department of Health and Human Services. Fact Sheet: Ransomware and HIPAA. Accessed at www.hhs.gov/sites/default/files/RansomwareFactSheet.pdf on 26 May 2017.<br />
# 45 C.F.R. § 164.302-.318 (2016).<br />
# Chen, BX. How to protect yourself from ransomware attacks. The New York Times. Published May 15, 2017. https://www.nytimes.com/2017/05/15/technology/personaltech/heres-how-to-protect-yourself-from-ransomware-attacks.html<br />
<br />
Submitted by Abigail Huang<br />
[[Category:BMI512-FALL-17]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/RansomwareRansomware2020-10-27T22:55:22Z<p>Samsun: /* WannaCry: Attack on the NHS – a primary care practice perspective */</p>
<hr />
<div>'''Ransomware''' is a type of [[malware|malware]] (malicious software) that limits users from accessing all or part of their computer unless a ransom is paid, often in the form of cryptocurrency such as Bitcoin.<br />
Some forms of ransomware lock a computer’s screen and display a demand for payment. [1] The victim’s files remain untouched, however, and this form of ransomware can sometimes be removed without paying the attacker. [2] Newer ransomware called ''cryptoviral extortion'' encrypts a user’s files. This more advanced form of malware renders files inaccessible even if the malware is removed. [3] Thus, the victim must pay the attacker for the decryption key in order to regain access to his files. <br />
<br />
== History of encrypting ransomware ==<br />
In 1989, Joseph Popp created the first known encrypting malware called the “AIDS Trojan” which was distributed on floppy disks via snail mail. This malware was limited in its design. The AIDS Trojan only encrypted the names of files and not the files themselves. Furthermore, the trojan used symmetric encryption (where the same key is used to encrypt and decrypt files) and the decryption key could be extracted from the code of the trojan. This made it unnecessary to pay ransom to reverse the effects of the trojan. [4]<br />
<br />
The idea of using asymmetric or public key [[encryption|encryption]] was introduced by researchers Adam L. Young and Moti Yung 1996 at an IEEE symposium. [5] Actual ransomware using this scheme became increasingly common after 2005. [6] In asymmetric encryption, a different key is used for encryption (the public key) and for decryption (the private key). The public key is used to encrypt the victim’s files while the private key is known only to the creators of the ransomware. The ransomware’s effects cannot be overcome without paying for the private key. [5]<br />
<br />
== Mechanism of encryption ==<br />
More recent malware such as CryptoLocker and WannaCry use a hybrid model combining asymmetric and symmetric encryption to capitalize on the strengths of both schemes. Using asymmetric keys allows the attackers to keep the private key secret. Symmetric keys allow encryption to occur more efficiently, enabling victim files to rapidly be encrypted. [7] <br />
# The attacker creates a key pair. The public key is placed in the code of the malware. The private key is kept secret and known only to the attacker. <br />
# When the malware is run on the victim’s computer, a random symmetric key is created locally and used to encrypt all of the victim’s files. This symmetric key is then itself encrypted by the public key in the malware and generates an asymmetric ciphertext. A message is sent to the victim with the asymmetric ciphertext and information on how to pay the ransom. The victim then sends both payment and the asymmetric ciphertext to the attacker. <br />
# When the ransom is received, the attacker uses the private key to decrypt the asymmetric ciphertext to reveal the victim’s symmetric key. The symmetric key is sent to the victim.<br />
# The victim then uses the symmetric key to decrypt the files. [8]<br />
<br />
== How ransomware infects computers == <br />
* Email – Emails may contain infected attachments or links to infected websites.<br />
* Compromised Websites – Websites may have exploit kits which can infect a computer without any clicking. These websites contain malicious code that take advantage of vulnerabilities in software or browsers. If such a vulnerability exists (e.g., software patches that are not up to date), the exploit kit uses the vulnerability to download ransomware. [9] [10] [11] Even visiting reputable websites can expose a victim to exploit kits. For example, in 2016, malicious advertisements containing exploit kits affected The New York Times, the BBC, MSN, and AOL. [12]<br />
* Wormlike behavior – Certain ransomware uses a computer’s software vulnerabilities to spread throughout networks. For example, WannaCry and Petya spread via EternalBlue MS17-010. It exploited a vulnerability in Microsoft Windows operating system, specifically the network file sharing protocol Server Message Block 1.0 (SMB). This vulnerability allowed “applications on a computer to read and write to file and request services”, and the ransomware was distributed throughout local networks without any user action. Computers without the appropriate security patch were then infected and could spread the ransomware further. [13] [14] <br />
<br />
== Ransomware targets healthcare == <br />
The healthcare industry is a prime target for cyberattacks such as ransomware for many reasons. <br />
=== Ease of attack ===<br />
Hospital networks are quickly expanding to meet government requirements such as increased electronic health record information exchange. [15] However, the cybersecurity of these networks is not as robust as that of other industries like finance. The primary focus of healthcare IT systems is often patient care and rapid accessibility rather than cybersecurity [16][17]. In fact, it is estimated that less than 5% of hospital IT budgets are spent on security and there are often long delays before security patches are implemented [18] [19]. Hospitals are thus seen as “soft targets.”<br />
=== Hospitals are more likely to pay ransom ===<br />
Hospitals depend on rapid access to data in order to provide patient care. Ransomware attacks can result in compromised delivery of healthcare and lawsuits if patients suffer harm from delayed or cancelled appointments and procedures. This makes hospitals more likely to pay ransom to quickly regain access to critical and often irreplaceable data. [6] [20] <br />
=== Healthcare data is valuable ===<br />
Health data includes sensitive information such as social security numbers, insurance details, addresses, etc. Attackers can use this extensive information to perpetrate medical fraud and identity theft, access financial information, and extort money by threatening to reveal a victim’s personal history (15). The variety of possible criminal uses makes healthcare data valuable. A single patient’s health record can be sold on the black market for between $1.50 and $10. [21] This is up to ten times more valuable than a person’s credit card details. [22] <br />
However, this black market price of a single complete health record has actually fallen in 2016 due to the growing supply of breached healthcare data. (In 2015, the Department of Health and Human Services’ Office for Civil Rights estimates 113 million healthcare records were breached. [23] Before these large breaches, in 2012, a single record used to fetch $50 to $60 dollars. This fall in health record price has actually encouraged the number of ransomware attacks as cybercriminals need to steal more health records (or extort ransom) in order to achieve the same profit. [21]<br />
<br />
<br />
The threat of ransomware to healthcare organizations is only expected to grow. The Verizon DBIR 2017 report showed that healthcare was the number two industry target for ransomware, behind Public Administration and ahead of Financial Services. In 2017, 72% of all malware incidents in the healthcare sector involved ransomware. [16] And the 2017 Experian Data Breach Industry Forecast report predicts that healthcare organizations will become the industry most heavily targeted by cybercriminals. [24] <br />
<br />
== Notable ransomware attacks on healthcare systems == <br />
<br />
* February 5, 2016 – Hollywood Presbyterian Medical Center, a 434-bed acute care hospital, experienced a Locky ransomware attack and lost access to its computer systems. This caused severe disruptions and hospital staff had to rely on pen-and-paper. The systems were restored after the Hollywood Presbyterian paid the attackers $17,000 in bitcoin ransom. [25]<br />
<br />
* March 28, 2016 – 10 hospitals and 250 outpatient centers in the MedStar network, Washington DC were affected by ransomware, forcing a temporary shutdown of electronic health and email systems. [26]<br />
<br />
* March 2016 – Methodist Hospital in Henderson, KY was affected by ransomware and declared an “internal state of emergency” for five days until data was restored from backups. [6] [27]<br />
<br />
* March 18, 2016 – Chino Valley Medical Center and Desert Valley Hospital in Southern CA were attacked by ransomware. Affected computers and some hospital servers were temporarily taken offline in order to prevent further spread. Patient health records were not compromised but the attack caused significant disruption. [28]<br />
<br />
* 2017 – UK National Health Service – The WannaCry ransomware variant affected 48 UK NHS hospital trusts. Doctor’s offices were shut down, affected hospitals diverted patients to other facilities, and non-critical appointments and surgeries were canceled. [29]<br />
<br />
* May 2017 – The first reports emerged of ransomware compromising medical devices in US hospitals. These attacks affected Bayer Medrad Windows-based devices [30]<br />
<br />
<br />
<br />
== WannaCry: Attack on the NHS – a primary care practice perspective ==<br />
--[[User:Samsun|Samsun]] ([[User talk:Samsun|talk]]) 22:51, 27 October 2020 (UTC)<br />
<br />
On May 12th, 2017, global ransomware called WannaCry locked out over 230,000 computers in at least 150 countries, including the NHS in the U.K.[1]. Although the NHS was not the primary target, this cyber attack directly affected 34 percent of the hospital trusts and 8 percent of primary care practices, causing significant disruption to the services due to the cancellation of thousands of patient visits and operations. During this time, primary care practices, although not directly affected, had to shut down the computer system to prevent any further spread. So, the practices had to resort to manual processes of recording notes, reporting test results, and referrals, not to mention managing the disgruntled patients, the subsequent backlog it created, especially catching up with the sudden influx of test results and letters and the time spend input all of the handwritten notes into the Electronic Health Record (EHR). <br />
<br />
It was reported that this ransomware, which exploited a known weakness in computers running Windows, could have been prevented had security updates from Microsoft were applied promptly, a robust firewall been set up on the NHS broadband network, and legacy platforms like Windows XP were updated to newer operating systems. No ransom was reportedly paid, and the malicious software was halted in the evening of the same day when an independent cybersecurity researcher inadvertently found and activated an inbuilt “kill-switch”[2]. Although a patch was released by Microsoft the following day, some primary care practices had to wait almost seven days before it was applied to their system, causing further disruption of services.<br />
<br />
A report published by the National Audit Office[3] highlighted that though the Department of Health had a plan to deal with such a situation, this had not been tested at a local level. The NHS had also not rehearsed for such a cyberattack, which led to the initial confusion as to who would lead the response to the attack. Though the need for maintaining emergency care was identified as a priority, there was a lack of clear and timely communication with all the relevant stakeholders. It is estimated that the WannaCry ransomware attack cost the NHS £92 million, which included £20 million due to lost outputs from canceled appointment and operations, and a further £72 million to deal with the aftermath related to the recovery of the data and the restoration of the systems[4].<br />
<br />
NHS England, in its report[1], acknowledged the inadequacies within the system and highlighted plans to strengthen NHS' cyber-security, based on the key lessons that were learned from the incident. These included developing a response plan in the event of a cyberattack and establishing the resources' roles and responsibilities. It also emphasized the need to have regular monitoring of all software, ensure that they are up to date, any critical patches are applied promptly, and ensure essential and timely communication with all relevant stakeholders. Above all, it emphasized leaders, organizations, and their staff's responsibility in taking cyber threats seriously, understanding the associated risks, and proactively taking measures to mitigate these risks.<br />
<br />
NHS Digital produced a Data Security Standards guide, which layouts ten standards to mitigate the risk of a future cyberattack, addressing issues around the three main entities – people, process, and technology. The fundamentals of it being:<br />
• People: ensure staff is equipped to handle information respectfully and safely, according to the Caldicott Principles.<br />
• Process: ensure the organization proactively prevents data security breaches and responds appropriately to incidents or near misses.<br />
• Technology: ensure technology is secure and up-to-date.<br />
<br />
Also, the Department of Health and Social care reported in 2018 that the NHS would spend £150 million to bolster its cybersecurity to prevent a further cyberattack like the WannaCry[5]. A subsequent report by Comparitech[6], a company that provides consumers privacy information, tools, and comparisons, underlines a relative reduction in the number of recent cyberattacks in the U.K., which according to them, could be a result of the “effective” measures implemented to thwart another cyberattack, with increased spending on measures to improve cybersecurity, practices, and training for their staff.<br />
<br />
== Impact of ransomware attacks on health systems == <br />
Ransomware attacks in healthcare systems are extremely damaging. First they endanger patient safety by preventing access to critical information in the medical record – e.g., allergies, medication lists, lab results, treatment plans, etc. Without this information, medical care can be rendered incorrectly or delayed. [20]<br />
<br />
'''Legal ramifications for hospitals'''<br />
<br />
As a result of the attack, a hospital may be subject to government action under the HIPAA Security Rule. [20] [31] A ransomware attack is considered a “security incident” defined as “attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.” Due to the increasing frequency of ransomware attacks, the U.S. Department of Health and Human Services released a fact sheet giving detailed guidance regarding ransomware and requirements such as reporting of security incidents. [32] This fact sheet clarified that a ransomware infection is considered a HIPAA breach, defined as “… the acquisition, access, use, or disclosure of PHI in a manner not permitted under the [HIPAA Privacy Rule] which comprises the security or privacy of the PHI.” [33] Specifically, ransomware encryption of protected health information is a breach since the data “was acquired (i.e., unauthorized individuals have taken possession or control of the information), and thus is a ‘disclosure’ not permitted under the HIPAA Privacy Rule.” [32]<br />
<br />
== How to prevent ransomware infections ==<br />
* Keep software updated with patches and security updates – this leaves fewer vulnerabilities for malware to exploit<br />
* Run antivirus software and keep it up-to-date <br />
* Do not click pop-up windows or links in suspicious emails. <br />
* Back up data so that if a system becomes infected, the data can be restored. <br />
* Have an organizational security plan<br />
# Set a companywide schedule for computers to get the latest software updates<br />
# Educate employees on security awareness and data hygiene [34]<br />
<br />
<br />
<br />
== References ==<br />
<br />
# Ransomware. Trend Micro. Published 2017. https://www.trendmicro.com/vinfo/us/security/definition/Ransomware.<br />
# Geier E. How to rescue your PC from ransomware. PCWorld. Published April 3, 2017. https://www.pcworld.com/article/2084002/security/how-to-rescue-your-pc-from-ransomware.html<br />
# Nagpal B, Wadhwa V. (2016) Cryptoviral Extortion: Evolution, Scenarios, and Analysis. In: Lobiyal D, Mohapatra D, Nagar A, Sahoo M. (eds) Proceedings of the International Conference on Signal, Networks, Computing, and Systems. Lecture Notes in Electrical Engineering, vol 396. Springer, New Delhi<br />
# Wilding E., Skulason F. (eds) Virus bulletin. The authoritative international publication on computer virus prevention, recognition, and removal. Published Jan 1990. https://www.virusbulletin.com/uploads/pdf/magazine/1990/199001.pdf <br />
# Young, A, Yung M. (1996). Cryptovirology: extortion-based security threats and countermeasures. IEEE Symposium on Security and Privacy. pp. 129–140. ISBN 0-8186-7417-2. doi:10.1109/SECPRI.1996.502676<br />
# Zetter Kim. Why hospitals are the perfect targets for ransomware. Wired. Published Mar. 30, 2016. https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/<br />
# Kappuswamy P, Al-Khalidi SQY. Hybrid encryption/decryption technique using new public key and symmetric key algorithm. MIS Review Vol. 19, No. 2, March (2014), pp. 1-13 DOI: 10.6131/MISR.2014.1902.01 https://pdfs.semanticscholar.org/87ff/ea85fbf52e22e4808e1fcc9e40ead4ff7738.pdf<br />
# Can files locked by WannaCry be decrypted: a technical analysis. Symantec. https://medium.com/threat-intel/wannacry-ransomware-decryption-821c7e3f0a2b<br />
# Crowe J. Ransomware FAQ: how ransomware infects your computer. Barkly. https://blog.barkly.com/how-ransomware-infects-computers#infection Published Sept 2016. <br />
# How ransomware infects computers. McAfee. https://www.mcafee.com/us/security-awareness/articles/how-ransomware-infects-computers.aspx<br />
# Ransomware FAQ. Windows Defender Security Intelligence. https://www.microsoft.com/en-us/wdsi/threats/ransomware<br />
# Goodin, D. Big-name sites hit by rash of malicious ads spreading crypto ransomware. Ars Technica. Published Mar 15, 2016. https://arstechnica.com/information-technology/2016/03/big-name-sites-hit-by-rash-of-malicious-ads-spreading-crypto-ransomware/<br />
# Grobman, S. WannaCry: the old worms and the new. McAfee. https://securingtomorrow.mcafee.com/executive-perspectives/wannacry-old-worms-new/ Published May 12, 2017.<br />
# Burgess, M. Everything you need to know about EternalBlue – the NSA exploit linked to Petya. Wired. Published June 28, 2017. https://www.wired.co.uk/article/what-is-eternal-blue-exploit-vulnerability-patch<br />
# Kruse CS, Frederick B, Jacobson T, Monticone DK. 2017. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technology and Health Care 25 (2017) 1-10. <br />
# 2017 Data breach investigations report. 10th ed. Verizon. http://www.verizonenterprise.com/verizon-insights-lab/dbir/2017/<br />
# Bai G, Jiang J, Flasher R. Hospital risk of data breaches. JAMA Intern Med. 2017;177(6):878-880. doi:10.1001/jamainternmed.2017.0336<br />
# AHC Media LLC. Hackers target hospitals with “ransomware”. ED LEGAL LETT. 2016 Apr; 27(4): also available https://www.ahcmedia.com/articles/137468-hackers-target-hospitals-with-ransomware<br />
# Newman, LH. The ransomware meltdown experts warned about is here. Wired. Published May 12, 2017. https://www.wired.com/2017/05/ransomware-meltdown-experts-warned/<br />
# Cohen IG, Hoffman S, Adashi EY. Your money or your patient’s life? Ransomware and electronic health records. Ann Intern Med. 2017;167(8):587-588<br />
# Increase in ransomware and cyberattacks linked to fall in price of health data. HIPAA Journal. Dec 2016. www.hipaajournal.com/increase-in-ransomware-and-cyberattacks-linked-to-fall-in-price-of-health-data-8622.<br />
# Chinthapalli K. The hackers holding hospitals to ransom. BMJ 2017;357:j2214<br />
# 2015: the year of the healthcare data breach. HIPAA Journal. Published Dec. 29, 2015. https://www.hipaajournal.com/2015-the-year-of-the-healthcare-data-breach-8239/<br />
# Fourth annual 2017 Data Breach industry forecast. Experian. https://www.experian.com/assets/data-breach/white-papers/2017-experian-data-breach-industry-forecast.pdf<br />
# Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Published Feb 18, 2016. http://www.latimes.com/business/technology/la-me-ln-hollywood-hospital-bitcoin-20160217-story.html<br />
# Virus forces shutdown of Medstar Health System’s 10-hospital computer network. HIPAA Journal. Published Mar. 29, 2016. https://www.hipaajournal.com/virus-forces-shutdown-medstar-health-systems-10-hospital-computer-network-3372/<br />
# Monegain B. Methodist Hospital recovering from five day ransomware attack, claims it did not pay up. HealthcareITNews. Published Mar. 22, 2016. http://www.healthcareitnews.com/news/methodist-hospital-recovering-five-day-ransomware-attack-claims-it-did-not-pay<br />
# Two more Californian hospital ransomware attacks reported. HIPAA Journal. Published Mar. 23, 2016. https://www.hipaajournal.com/two-more-californian-hospital-ransomware-attacks-reported-3368/<br />
# Erlanger S, Bilefsky D, Chan S. U.K. Health Service ignored warnings for months. The New York Times. Published May 12, 2017. https://www.nytimes.com/2017/05/12/world/europe/nhs-cyberattack-warnings.html<br />
# Fox-Brewster, T. Medical devices hit by ransomware for the first time in US hospitals. Forbes. Published May 17, 2017. https://www.forbes.com/sites/thomasbrewster/2017/05/17/wannacry-ransomware-hit-real-medical-devices/#75b8806b425c<br />
# Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-91 (1996).<br />
# Department of Health and Human Services. Fact Sheet: Ransomware and HIPAA. Accessed at www.hhs.gov/sites/default/files/RansomwareFactSheet.pdf on 26 May 2017.<br />
# 45 C.F.R. § 164.302-.318 (2016).<br />
# Chen, BX. How to protect yourself from ransomware attacks. The New York Times. Published May 15, 2017. https://www.nytimes.com/2017/05/15/technology/personaltech/heres-how-to-protect-yourself-from-ransomware-attacks.html<br />
<br />
Submitted by Abigail Huang<br />
[[Category:BMI512-FALL-17]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/RansomwareRansomware2020-10-27T22:53:40Z<p>Samsun: </p>
<hr />
<div>'''Ransomware''' is a type of [[malware|malware]] (malicious software) that limits users from accessing all or part of their computer unless a ransom is paid, often in the form of cryptocurrency such as Bitcoin.<br />
Some forms of ransomware lock a computer’s screen and display a demand for payment. [1] The victim’s files remain untouched, however, and this form of ransomware can sometimes be removed without paying the attacker. [2] Newer ransomware called ''cryptoviral extortion'' encrypts a user’s files. This more advanced form of malware renders files inaccessible even if the malware is removed. [3] Thus, the victim must pay the attacker for the decryption key in order to regain access to his files. <br />
<br />
== History of encrypting ransomware ==<br />
In 1989, Joseph Popp created the first known encrypting malware called the “AIDS Trojan” which was distributed on floppy disks via snail mail. This malware was limited in its design. The AIDS Trojan only encrypted the names of files and not the files themselves. Furthermore, the trojan used symmetric encryption (where the same key is used to encrypt and decrypt files) and the decryption key could be extracted from the code of the trojan. This made it unnecessary to pay ransom to reverse the effects of the trojan. [4]<br />
<br />
The idea of using asymmetric or public key [[encryption|encryption]] was introduced by researchers Adam L. Young and Moti Yung 1996 at an IEEE symposium. [5] Actual ransomware using this scheme became increasingly common after 2005. [6] In asymmetric encryption, a different key is used for encryption (the public key) and for decryption (the private key). The public key is used to encrypt the victim’s files while the private key is known only to the creators of the ransomware. The ransomware’s effects cannot be overcome without paying for the private key. [5]<br />
<br />
== Mechanism of encryption ==<br />
More recent malware such as CryptoLocker and WannaCry use a hybrid model combining asymmetric and symmetric encryption to capitalize on the strengths of both schemes. Using asymmetric keys allows the attackers to keep the private key secret. Symmetric keys allow encryption to occur more efficiently, enabling victim files to rapidly be encrypted. [7] <br />
# The attacker creates a key pair. The public key is placed in the code of the malware. The private key is kept secret and known only to the attacker. <br />
# When the malware is run on the victim’s computer, a random symmetric key is created locally and used to encrypt all of the victim’s files. This symmetric key is then itself encrypted by the public key in the malware and generates an asymmetric ciphertext. A message is sent to the victim with the asymmetric ciphertext and information on how to pay the ransom. The victim then sends both payment and the asymmetric ciphertext to the attacker. <br />
# When the ransom is received, the attacker uses the private key to decrypt the asymmetric ciphertext to reveal the victim’s symmetric key. The symmetric key is sent to the victim.<br />
# The victim then uses the symmetric key to decrypt the files. [8]<br />
<br />
== How ransomware infects computers == <br />
* Email – Emails may contain infected attachments or links to infected websites.<br />
* Compromised Websites – Websites may have exploit kits which can infect a computer without any clicking. These websites contain malicious code that take advantage of vulnerabilities in software or browsers. If such a vulnerability exists (e.g., software patches that are not up to date), the exploit kit uses the vulnerability to download ransomware. [9] [10] [11] Even visiting reputable websites can expose a victim to exploit kits. For example, in 2016, malicious advertisements containing exploit kits affected The New York Times, the BBC, MSN, and AOL. [12]<br />
* Wormlike behavior – Certain ransomware uses a computer’s software vulnerabilities to spread throughout networks. For example, WannaCry and Petya spread via EternalBlue MS17-010. It exploited a vulnerability in Microsoft Windows operating system, specifically the network file sharing protocol Server Message Block 1.0 (SMB). This vulnerability allowed “applications on a computer to read and write to file and request services”, and the ransomware was distributed throughout local networks without any user action. Computers without the appropriate security patch were then infected and could spread the ransomware further. [13] [14] <br />
<br />
== Ransomware targets healthcare == <br />
The healthcare industry is a prime target for cyberattacks such as ransomware for many reasons. <br />
=== Ease of attack ===<br />
Hospital networks are quickly expanding to meet government requirements such as increased electronic health record information exchange. [15] However, the cybersecurity of these networks is not as robust as that of other industries like finance. The primary focus of healthcare IT systems is often patient care and rapid accessibility rather than cybersecurity [16][17]. In fact, it is estimated that less than 5% of hospital IT budgets are spent on security and there are often long delays before security patches are implemented [18] [19]. Hospitals are thus seen as “soft targets.”<br />
=== Hospitals are more likely to pay ransom ===<br />
Hospitals depend on rapid access to data in order to provide patient care. Ransomware attacks can result in compromised delivery of healthcare and lawsuits if patients suffer harm from delayed or cancelled appointments and procedures. This makes hospitals more likely to pay ransom to quickly regain access to critical and often irreplaceable data. [6] [20] <br />
=== Healthcare data is valuable ===<br />
Health data includes sensitive information such as social security numbers, insurance details, addresses, etc. Attackers can use this extensive information to perpetrate medical fraud and identity theft, access financial information, and extort money by threatening to reveal a victim’s personal history (15). The variety of possible criminal uses makes healthcare data valuable. A single patient’s health record can be sold on the black market for between $1.50 and $10. [21] This is up to ten times more valuable than a person’s credit card details. [22] <br />
However, this black market price of a single complete health record has actually fallen in 2016 due to the growing supply of breached healthcare data. (In 2015, the Department of Health and Human Services’ Office for Civil Rights estimates 113 million healthcare records were breached. [23] Before these large breaches, in 2012, a single record used to fetch $50 to $60 dollars. This fall in health record price has actually encouraged the number of ransomware attacks as cybercriminals need to steal more health records (or extort ransom) in order to achieve the same profit. [21]<br />
<br />
<br />
The threat of ransomware to healthcare organizations is only expected to grow. The Verizon DBIR 2017 report showed that healthcare was the number two industry target for ransomware, behind Public Administration and ahead of Financial Services. In 2017, 72% of all malware incidents in the healthcare sector involved ransomware. [16] And the 2017 Experian Data Breach Industry Forecast report predicts that healthcare organizations will become the industry most heavily targeted by cybercriminals. [24] <br />
<br />
== Notable ransomware attacks on healthcare systems == <br />
<br />
* February 5, 2016 – Hollywood Presbyterian Medical Center, a 434-bed acute care hospital, experienced a Locky ransomware attack and lost access to its computer systems. This caused severe disruptions and hospital staff had to rely on pen-and-paper. The systems were restored after the Hollywood Presbyterian paid the attackers $17,000 in bitcoin ransom. [25]<br />
<br />
* March 28, 2016 – 10 hospitals and 250 outpatient centers in the MedStar network, Washington DC were affected by ransomware, forcing a temporary shutdown of electronic health and email systems. [26]<br />
<br />
* March 2016 – Methodist Hospital in Henderson, KY was affected by ransomware and declared an “internal state of emergency” for five days until data was restored from backups. [6] [27]<br />
<br />
* March 18, 2016 – Chino Valley Medical Center and Desert Valley Hospital in Southern CA were attacked by ransomware. Affected computers and some hospital servers were temporarily taken offline in order to prevent further spread. Patient health records were not compromised but the attack caused significant disruption. [28]<br />
<br />
* 2017 – UK National Health Service – The WannaCry ransomware variant affected 48 UK NHS hospital trusts. Doctor’s offices were shut down, affected hospitals diverted patients to other facilities, and non-critical appointments and surgeries were canceled. [29]<br />
<br />
* May 2017 – The first reports emerged of ransomware compromising medical devices in US hospitals. These attacks affected Bayer Medrad Windows-based devices [30]<br />
<br />
<br />
<br />
== WannaCry: Attack on the NHS – a primary care practice perspective ==<br />
--[[User:Samsun|Samsun]] ([[User talk:Samsun|talk]]) 22:51, 27 October 2020 (UTC)<br />
<br />
On May 12th, 2017, global ransomware called WannaCry locked out over 230,000 computers in at least 150 countries, including the NHS in the U.K.[1]. Although the NHS was not the primary target, this cyber attack directly affected 34 percent of the hospital trusts and 8 percent of primary care practices, causing significant disruption to the services due to the cancellation of thousands of patient visits and operations. During this time, primary care practices, although not directly affected, had to shut down the computer system to prevent any further spread. So, the practices had to resort to manual processes of recording notes, reporting test results, and referrals, not to mention managing the disgruntled patients, the subsequent backlog it created, especially catching up with the sudden influx of test results and letters and the time spend input all of the handwritten notes into the Electronic Health Record (EHR). <br />
<br />
It was reported that this ransomware, which exploited a known weakness in computers running Windows, could have been prevented had security updates from Microsoft were applied promptly, a robust firewall been set up on the NHS broadband network, and legacy platforms like Windows XP were updated to newer operating systems. No ransom was reportedly paid, and the malicious software was halted in the evening of the same day when an independent cybersecurity researcher inadvertently found and activated an inbuilt “kill-switch”[2]. Although a patch was released by Microsoft the following day, some primary care practices had to wait almost seven days before it was applied to their system, causing further disruption of services.<br />
<br />
A report published by the National Audit Office[3] highlighted that though the Department of Health had a plan to deal with such a situation, this had not been tested at a local level. The NHS had also not rehearsed for such a cyberattack, which led to the initial confusion as to who would lead the response to the attack. Though the need for maintaining emergency care was identified as a priority, there was a lack of clear and timely communication with all the relevant stakeholders. It is estimated that the WannaCry ransomware attack cost the NHS £92 million, which included £20 million due to lost outputs from canceled appointment and operations, and a further £72 million to deal with the aftermath related to the recovery of the data and the restoration of the systems[4].<br />
<br />
NHS England, in its report[1], acknowledged the inadequacies within the system and highlighted plans to strengthen NHS' cyber-security, based on the key lessons that were learned from the incident. These included developing a response plan in the event of a cyberattack and establishing the resources' roles and responsibilities. It also emphasized the need to have regular monitoring of all software, ensure that they are up to date, any critical patches are applied promptly, and ensure essential and timely communication with all relevant stakeholders. Above all, it emphasized leaders, organizations, and their staff's responsibility in taking cyber threats seriously, understanding the associated risks, and proactively taking measures to mitigate these risks.<br />
<br />
NHS Digital produced a Data Security Standards guide, which layouts ten standards to mitigate the risk of a future cyberattack, addressing issues around the three main entities – people, process, and technology. The fundamentals of it being:<br />
People: ensure staff is equipped to handle information respectfully and safely, according to the Caldicott Principles.<br />
Process: ensure the organization proactively prevents data security breaches and responds appropriately to incidents or near misses.<br />
Technology: ensure technology is secure and up-to-date.<br />
<br />
Also, the Department of Health and Social care reported in 2018 that the NHS would spend £150 million to bolster its cybersecurity to prevent a further cyberattack like the WannaCry[5]. A subsequent report by Comparitech[6], a company that provides consumers privacy information, tools, and comparisons, underlines a relative reduction in the number of recent cyberattacks in the U.K., which according to them, could be a result of the “effective” measures implemented to thwart another cyberattack, with increased spending on measures to improve cybersecurity, practices, and training for their staff.<br />
<br />
<br />
== Impact of ransomware attacks on health systems == <br />
Ransomware attacks in healthcare systems are extremely damaging. First they endanger patient safety by preventing access to critical information in the medical record – e.g., allergies, medication lists, lab results, treatment plans, etc. Without this information, medical care can be rendered incorrectly or delayed. [20]<br />
<br />
'''Legal ramifications for hospitals'''<br />
<br />
As a result of the attack, a hospital may be subject to government action under the HIPAA Security Rule. [20] [31] A ransomware attack is considered a “security incident” defined as “attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.” Due to the increasing frequency of ransomware attacks, the U.S. Department of Health and Human Services released a fact sheet giving detailed guidance regarding ransomware and requirements such as reporting of security incidents. [32] This fact sheet clarified that a ransomware infection is considered a HIPAA breach, defined as “… the acquisition, access, use, or disclosure of PHI in a manner not permitted under the [HIPAA Privacy Rule] which comprises the security or privacy of the PHI.” [33] Specifically, ransomware encryption of protected health information is a breach since the data “was acquired (i.e., unauthorized individuals have taken possession or control of the information), and thus is a ‘disclosure’ not permitted under the HIPAA Privacy Rule.” [32]<br />
<br />
== How to prevent ransomware infections ==<br />
* Keep software updated with patches and security updates – this leaves fewer vulnerabilities for malware to exploit<br />
* Run antivirus software and keep it up-to-date <br />
* Do not click pop-up windows or links in suspicious emails. <br />
* Back up data so that if a system becomes infected, the data can be restored. <br />
* Have an organizational security plan<br />
# Set a companywide schedule for computers to get the latest software updates<br />
# Educate employees on security awareness and data hygiene [34]<br />
<br />
<br />
<br />
== References ==<br />
<br />
# Ransomware. Trend Micro. Published 2017. https://www.trendmicro.com/vinfo/us/security/definition/Ransomware.<br />
# Geier E. How to rescue your PC from ransomware. PCWorld. Published April 3, 2017. https://www.pcworld.com/article/2084002/security/how-to-rescue-your-pc-from-ransomware.html<br />
# Nagpal B, Wadhwa V. (2016) Cryptoviral Extortion: Evolution, Scenarios, and Analysis. In: Lobiyal D, Mohapatra D, Nagar A, Sahoo M. (eds) Proceedings of the International Conference on Signal, Networks, Computing, and Systems. Lecture Notes in Electrical Engineering, vol 396. Springer, New Delhi<br />
# Wilding E., Skulason F. (eds) Virus bulletin. The authoritative international publication on computer virus prevention, recognition, and removal. Published Jan 1990. https://www.virusbulletin.com/uploads/pdf/magazine/1990/199001.pdf <br />
# Young, A, Yung M. (1996). Cryptovirology: extortion-based security threats and countermeasures. IEEE Symposium on Security and Privacy. pp. 129–140. ISBN 0-8186-7417-2. doi:10.1109/SECPRI.1996.502676<br />
# Zetter Kim. Why hospitals are the perfect targets for ransomware. Wired. Published Mar. 30, 2016. https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/<br />
# Kappuswamy P, Al-Khalidi SQY. Hybrid encryption/decryption technique using new public key and symmetric key algorithm. MIS Review Vol. 19, No. 2, March (2014), pp. 1-13 DOI: 10.6131/MISR.2014.1902.01 https://pdfs.semanticscholar.org/87ff/ea85fbf52e22e4808e1fcc9e40ead4ff7738.pdf<br />
# Can files locked by WannaCry be decrypted: a technical analysis. Symantec. https://medium.com/threat-intel/wannacry-ransomware-decryption-821c7e3f0a2b<br />
# Crowe J. Ransomware FAQ: how ransomware infects your computer. Barkly. https://blog.barkly.com/how-ransomware-infects-computers#infection Published Sept 2016. <br />
# How ransomware infects computers. McAfee. https://www.mcafee.com/us/security-awareness/articles/how-ransomware-infects-computers.aspx<br />
# Ransomware FAQ. Windows Defender Security Intelligence. https://www.microsoft.com/en-us/wdsi/threats/ransomware<br />
# Goodin, D. Big-name sites hit by rash of malicious ads spreading crypto ransomware. Ars Technica. Published Mar 15, 2016. https://arstechnica.com/information-technology/2016/03/big-name-sites-hit-by-rash-of-malicious-ads-spreading-crypto-ransomware/<br />
# Grobman, S. WannaCry: the old worms and the new. McAfee. https://securingtomorrow.mcafee.com/executive-perspectives/wannacry-old-worms-new/ Published May 12, 2017.<br />
# Burgess, M. Everything you need to know about EternalBlue – the NSA exploit linked to Petya. Wired. Published June 28, 2017. https://www.wired.co.uk/article/what-is-eternal-blue-exploit-vulnerability-patch<br />
# Kruse CS, Frederick B, Jacobson T, Monticone DK. 2017. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technology and Health Care 25 (2017) 1-10. <br />
# 2017 Data breach investigations report. 10th ed. Verizon. http://www.verizonenterprise.com/verizon-insights-lab/dbir/2017/<br />
# Bai G, Jiang J, Flasher R. Hospital risk of data breaches. JAMA Intern Med. 2017;177(6):878-880. doi:10.1001/jamainternmed.2017.0336<br />
# AHC Media LLC. Hackers target hospitals with “ransomware”. ED LEGAL LETT. 2016 Apr; 27(4): also available https://www.ahcmedia.com/articles/137468-hackers-target-hospitals-with-ransomware<br />
# Newman, LH. The ransomware meltdown experts warned about is here. Wired. Published May 12, 2017. https://www.wired.com/2017/05/ransomware-meltdown-experts-warned/<br />
# Cohen IG, Hoffman S, Adashi EY. Your money or your patient’s life? Ransomware and electronic health records. Ann Intern Med. 2017;167(8):587-588<br />
# Increase in ransomware and cyberattacks linked to fall in price of health data. HIPAA Journal. Dec 2016. www.hipaajournal.com/increase-in-ransomware-and-cyberattacks-linked-to-fall-in-price-of-health-data-8622.<br />
# Chinthapalli K. The hackers holding hospitals to ransom. BMJ 2017;357:j2214<br />
# 2015: the year of the healthcare data breach. HIPAA Journal. Published Dec. 29, 2015. https://www.hipaajournal.com/2015-the-year-of-the-healthcare-data-breach-8239/<br />
# Fourth annual 2017 Data Breach industry forecast. Experian. https://www.experian.com/assets/data-breach/white-papers/2017-experian-data-breach-industry-forecast.pdf<br />
# Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Published Feb 18, 2016. http://www.latimes.com/business/technology/la-me-ln-hollywood-hospital-bitcoin-20160217-story.html<br />
# Virus forces shutdown of Medstar Health System’s 10-hospital computer network. HIPAA Journal. Published Mar. 29, 2016. https://www.hipaajournal.com/virus-forces-shutdown-medstar-health-systems-10-hospital-computer-network-3372/<br />
# Monegain B. Methodist Hospital recovering from five day ransomware attack, claims it did not pay up. HealthcareITNews. Published Mar. 22, 2016. http://www.healthcareitnews.com/news/methodist-hospital-recovering-five-day-ransomware-attack-claims-it-did-not-pay<br />
# Two more Californian hospital ransomware attacks reported. HIPAA Journal. Published Mar. 23, 2016. https://www.hipaajournal.com/two-more-californian-hospital-ransomware-attacks-reported-3368/<br />
# Erlanger S, Bilefsky D, Chan S. U.K. Health Service ignored warnings for months. The New York Times. Published May 12, 2017. https://www.nytimes.com/2017/05/12/world/europe/nhs-cyberattack-warnings.html<br />
# Fox-Brewster, T. Medical devices hit by ransomware for the first time in US hospitals. Forbes. Published May 17, 2017. https://www.forbes.com/sites/thomasbrewster/2017/05/17/wannacry-ransomware-hit-real-medical-devices/#75b8806b425c<br />
# Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-91 (1996).<br />
# Department of Health and Human Services. Fact Sheet: Ransomware and HIPAA. Accessed at www.hhs.gov/sites/default/files/RansomwareFactSheet.pdf on 26 May 2017.<br />
# 45 C.F.R. § 164.302-.318 (2016).<br />
# Chen, BX. How to protect yourself from ransomware attacks. The New York Times. Published May 15, 2017. https://www.nytimes.com/2017/05/15/technology/personaltech/heres-how-to-protect-yourself-from-ransomware-attacks.html<br />
<br />
Submitted by Abigail Huang<br />
[[Category:BMI512-FALL-17]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/RansomwareRansomware2020-10-27T22:52:41Z<p>Samsun: </p>
<hr />
<div>'''Ransomware''' is a type of [[malware|malware]] (malicious software) that limits users from accessing all or part of their computer unless a ransom is paid, often in the form of cryptocurrency such as Bitcoin.<br />
Some forms of ransomware lock a computer’s screen and display a demand for payment. [1] The victim’s files remain untouched, however, and this form of ransomware can sometimes be removed without paying the attacker. [2] Newer ransomware called ''cryptoviral extortion'' encrypts a user’s files. This more advanced form of malware renders files inaccessible even if the malware is removed. [3] Thus, the victim must pay the attacker for the decryption key in order to regain access to his files. <br />
<br />
== History of encrypting ransomware ==<br />
In 1989, Joseph Popp created the first known encrypting malware called the “AIDS Trojan” which was distributed on floppy disks via snail mail. This malware was limited in its design. The AIDS Trojan only encrypted the names of files and not the files themselves. Furthermore, the trojan used symmetric encryption (where the same key is used to encrypt and decrypt files) and the decryption key could be extracted from the code of the trojan. This made it unnecessary to pay ransom to reverse the effects of the trojan. [4]<br />
<br />
The idea of using asymmetric or public key [[encryption|encryption]] was introduced by researchers Adam L. Young and Moti Yung 1996 at an IEEE symposium. [5] Actual ransomware using this scheme became increasingly common after 2005. [6] In asymmetric encryption, a different key is used for encryption (the public key) and for decryption (the private key). The public key is used to encrypt the victim’s files while the private key is known only to the creators of the ransomware. The ransomware’s effects cannot be overcome without paying for the private key. [5]<br />
<br />
== Mechanism of encryption ==<br />
More recent malware such as CryptoLocker and WannaCry use a hybrid model combining asymmetric and symmetric encryption to capitalize on the strengths of both schemes. Using asymmetric keys allows the attackers to keep the private key secret. Symmetric keys allow encryption to occur more efficiently, enabling victim files to rapidly be encrypted. [7] <br />
# The attacker creates a key pair. The public key is placed in the code of the malware. The private key is kept secret and known only to the attacker. <br />
# When the malware is run on the victim’s computer, a random symmetric key is created locally and used to encrypt all of the victim’s files. This symmetric key is then itself encrypted by the public key in the malware and generates an asymmetric ciphertext. A message is sent to the victim with the asymmetric ciphertext and information on how to pay the ransom. The victim then sends both payment and the asymmetric ciphertext to the attacker. <br />
# When the ransom is received, the attacker uses the private key to decrypt the asymmetric ciphertext to reveal the victim’s symmetric key. The symmetric key is sent to the victim.<br />
# The victim then uses the symmetric key to decrypt the files. [8]<br />
<br />
== How ransomware infects computers == <br />
* Email – Emails may contain infected attachments or links to infected websites.<br />
* Compromised Websites – Websites may have exploit kits which can infect a computer without any clicking. These websites contain malicious code that take advantage of vulnerabilities in software or browsers. If such a vulnerability exists (e.g., software patches that are not up to date), the exploit kit uses the vulnerability to download ransomware. [9] [10] [11] Even visiting reputable websites can expose a victim to exploit kits. For example, in 2016, malicious advertisements containing exploit kits affected The New York Times, the BBC, MSN, and AOL. [12]<br />
* Wormlike behavior – Certain ransomware uses a computer’s software vulnerabilities to spread throughout networks. For example, WannaCry and Petya spread via EternalBlue MS17-010. It exploited a vulnerability in Microsoft Windows operating system, specifically the network file sharing protocol Server Message Block 1.0 (SMB). This vulnerability allowed “applications on a computer to read and write to file and request services”, and the ransomware was distributed throughout local networks without any user action. Computers without the appropriate security patch were then infected and could spread the ransomware further. [13] [14] <br />
<br />
== Ransomware targets healthcare == <br />
The healthcare industry is a prime target for cyberattacks such as ransomware for many reasons. <br />
=== Ease of attack ===<br />
Hospital networks are quickly expanding to meet government requirements such as increased electronic health record information exchange. [15] However, the cybersecurity of these networks is not as robust as that of other industries like finance. The primary focus of healthcare IT systems is often patient care and rapid accessibility rather than cybersecurity [16][17]. In fact, it is estimated that less than 5% of hospital IT budgets are spent on security and there are often long delays before security patches are implemented [18] [19]. Hospitals are thus seen as “soft targets.”<br />
=== Hospitals are more likely to pay ransom ===<br />
Hospitals depend on rapid access to data in order to provide patient care. Ransomware attacks can result in compromised delivery of healthcare and lawsuits if patients suffer harm from delayed or cancelled appointments and procedures. This makes hospitals more likely to pay ransom to quickly regain access to critical and often irreplaceable data. [6] [20] <br />
=== Healthcare data is valuable ===<br />
Health data includes sensitive information such as social security numbers, insurance details, addresses, etc. Attackers can use this extensive information to perpetrate medical fraud and identity theft, access financial information, and extort money by threatening to reveal a victim’s personal history (15). The variety of possible criminal uses makes healthcare data valuable. A single patient’s health record can be sold on the black market for between $1.50 and $10. [21] This is up to ten times more valuable than a person’s credit card details. [22] <br />
However, this black market price of a single complete health record has actually fallen in 2016 due to the growing supply of breached healthcare data. (In 2015, the Department of Health and Human Services’ Office for Civil Rights estimates 113 million healthcare records were breached. [23] Before these large breaches, in 2012, a single record used to fetch $50 to $60 dollars. This fall in health record price has actually encouraged the number of ransomware attacks as cybercriminals need to steal more health records (or extort ransom) in order to achieve the same profit. [21]<br />
<br />
<br />
The threat of ransomware to healthcare organizations is only expected to grow. The Verizon DBIR 2017 report showed that healthcare was the number two industry target for ransomware, behind Public Administration and ahead of Financial Services. In 2017, 72% of all malware incidents in the healthcare sector involved ransomware. [16] And the 2017 Experian Data Breach Industry Forecast report predicts that healthcare organizations will become the industry most heavily targeted by cybercriminals. [24] <br />
<br />
== Notable ransomware attacks on healthcare systems == <br />
<br />
* February 5, 2016 – Hollywood Presbyterian Medical Center, a 434-bed acute care hospital, experienced a Locky ransomware attack and lost access to its computer systems. This caused severe disruptions and hospital staff had to rely on pen-and-paper. The systems were restored after the Hollywood Presbyterian paid the attackers $17,000 in bitcoin ransom. [25]<br />
<br />
* March 28, 2016 – 10 hospitals and 250 outpatient centers in the MedStar network, Washington DC were affected by ransomware, forcing a temporary shutdown of electronic health and email systems. [26]<br />
<br />
* March 2016 – Methodist Hospital in Henderson, KY was affected by ransomware and declared an “internal state of emergency” for five days until data was restored from backups. [6] [27]<br />
<br />
* March 18, 2016 – Chino Valley Medical Center and Desert Valley Hospital in Southern CA were attacked by ransomware. Affected computers and some hospital servers were temporarily taken offline in order to prevent further spread. Patient health records were not compromised but the attack caused significant disruption. [28]<br />
<br />
* 2017 – UK National Health Service – The WannaCry ransomware variant affected 48 UK NHS hospital trusts. Doctor’s offices were shut down, affected hospitals diverted patients to other facilities, and non-critical appointments and surgeries were canceled. [29]<br />
<br />
* May 2017 – The first reports emerged of ransomware compromising medical devices in US hospitals. These attacks affected Bayer Medrad Windows-based devices [30]<br />
<br />
<br />
<br />
== WannaCry: Attack on the NHS – a primary care practice perspective ==<br />
--[[User:Samsun|Samsun]] ([[User talk:Samsun|talk]]) 22:51, 27 October 2020 (UTC)<br />
<br />
On May 12th, 2017, global ransomware called WannaCry locked out over 230,000 computers in at least 150 countries, including the NHS in the U.K.[1]. Although the NHS was not the primary target, this cyber attack directly affected 34 percent of the hospital trusts and 8 percent of primary care practices, causing significant disruption to the services due to the cancellation of thousands of patient visits and operations. During this time, primary care practices, although not directly affected, had to shut down the computer system to prevent any further spread. So, the practices had to resort to manual processes of recording notes, reporting test results, and referrals, not to mention managing the disgruntled patients, the subsequent backlog it created, especially catching up with the sudden influx of test results and letters and the time spend input all of the handwritten notes into the Electronic Health Record (EHR). <br />
<br />
It was reported that this ransomware, which exploited a known weakness in computers running Windows, could have been prevented had security updates from Microsoft were applied promptly, a robust firewall been set up on the NHS broadband network, and legacy platforms like Windows XP were updated to newer operating systems. No ransom was reportedly paid, and the malicious software was halted in the evening of the same day when an independent cybersecurity researcher inadvertently found and activated an inbuilt “kill-switch”[2]. Although a patch was released by Microsoft the following day, some primary care practices had to wait almost seven days before it was applied to their system, causing further disruption of services.<br />
<br />
A report published by the National Audit Office[3] highlighted that though the Department of Health had a plan to deal with such a situation, this had not been tested at a local level. The NHS had also not rehearsed for such a cyberattack, which led to the initial confusion as to who would lead the response to the attack. Though the need for maintaining emergency care was identified as a priority, there was a lack of clear and timely communication with all the relevant stakeholders. It is estimated that the WannaCry ransomware attack cost the NHS £92 million, which included £20 million due to lost outputs from canceled appointment and operations, and a further £72 million to deal with the aftermath related to the recovery of the data and the restoration of the systems[4].<br />
<br />
NHS England, in its report[1], acknowledged the inadequacies within the system and highlighted plans to strengthen NHS' cyber-security, based on the key lessons that were learned from the incident. These included developing a response plan in the event of a cyberattack and establishing the resources' roles and responsibilities. It also emphasized the need to have regular monitoring of all software, ensure that they are up to date, any critical patches are applied promptly, and ensure essential and timely communication with all relevant stakeholders. Above all, it emphasized leaders, organizations, and their staff's responsibility in taking cyber threats seriously, understanding the associated risks, and proactively taking measures to mitigate these risks.<br />
<br />
NHS Digital produced a Data Security Standards guide, which layouts ten standards to mitigate the risk of a future cyberattack, addressing issues around the three main entities – people, process, and technology. The fundamentals of it being:<br />
''People: ensure staff is equipped to handle information respectfully and safely, according to the Caldicott Principles.''<br />
<br />
''Process: ensure the organization proactively prevents data security breaches and responds appropriately to incidents or near misses.''<br />
<br />
''Technology: ensure technology is secure and up-to-date.''<br />
<br />
Also, the Department of Health and Social care reported in 2018 that the NHS would spend £150 million to bolster its cybersecurity to prevent a further cyberattack like the WannaCry[5]. A subsequent report by Comparitech[6], a company that provides consumers privacy information, tools, and comparisons, underlines a relative reduction in the number of recent cyberattacks in the U.K., which according to them, could be a result of the “effective” measures implemented to thwart another cyberattack, with increased spending on measures to improve cybersecurity, practices, and training for their staff.<br />
<br />
<br />
== Impact of ransomware attacks on health systems == <br />
Ransomware attacks in healthcare systems are extremely damaging. First they endanger patient safety by preventing access to critical information in the medical record – e.g., allergies, medication lists, lab results, treatment plans, etc. Without this information, medical care can be rendered incorrectly or delayed. [20]<br />
<br />
'''Legal ramifications for hospitals'''<br />
<br />
As a result of the attack, a hospital may be subject to government action under the HIPAA Security Rule. [20] [31] A ransomware attack is considered a “security incident” defined as “attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.” Due to the increasing frequency of ransomware attacks, the U.S. Department of Health and Human Services released a fact sheet giving detailed guidance regarding ransomware and requirements such as reporting of security incidents. [32] This fact sheet clarified that a ransomware infection is considered a HIPAA breach, defined as “… the acquisition, access, use, or disclosure of PHI in a manner not permitted under the [HIPAA Privacy Rule] which comprises the security or privacy of the PHI.” [33] Specifically, ransomware encryption of protected health information is a breach since the data “was acquired (i.e., unauthorized individuals have taken possession or control of the information), and thus is a ‘disclosure’ not permitted under the HIPAA Privacy Rule.” [32]<br />
<br />
== How to prevent ransomware infections ==<br />
* Keep software updated with patches and security updates – this leaves fewer vulnerabilities for malware to exploit<br />
* Run antivirus software and keep it up-to-date <br />
* Do not click pop-up windows or links in suspicious emails. <br />
* Back up data so that if a system becomes infected, the data can be restored. <br />
* Have an organizational security plan<br />
# Set a companywide schedule for computers to get the latest software updates<br />
# Educate employees on security awareness and data hygiene [34]<br />
<br />
<br />
<br />
== References ==<br />
<br />
# Ransomware. Trend Micro. Published 2017. https://www.trendmicro.com/vinfo/us/security/definition/Ransomware.<br />
# Geier E. How to rescue your PC from ransomware. PCWorld. Published April 3, 2017. https://www.pcworld.com/article/2084002/security/how-to-rescue-your-pc-from-ransomware.html<br />
# Nagpal B, Wadhwa V. (2016) Cryptoviral Extortion: Evolution, Scenarios, and Analysis. In: Lobiyal D, Mohapatra D, Nagar A, Sahoo M. (eds) Proceedings of the International Conference on Signal, Networks, Computing, and Systems. Lecture Notes in Electrical Engineering, vol 396. Springer, New Delhi<br />
# Wilding E., Skulason F. (eds) Virus bulletin. The authoritative international publication on computer virus prevention, recognition, and removal. Published Jan 1990. https://www.virusbulletin.com/uploads/pdf/magazine/1990/199001.pdf <br />
# Young, A, Yung M. (1996). Cryptovirology: extortion-based security threats and countermeasures. IEEE Symposium on Security and Privacy. pp. 129–140. ISBN 0-8186-7417-2. doi:10.1109/SECPRI.1996.502676<br />
# Zetter Kim. Why hospitals are the perfect targets for ransomware. Wired. Published Mar. 30, 2016. https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/<br />
# Kappuswamy P, Al-Khalidi SQY. Hybrid encryption/decryption technique using new public key and symmetric key algorithm. MIS Review Vol. 19, No. 2, March (2014), pp. 1-13 DOI: 10.6131/MISR.2014.1902.01 https://pdfs.semanticscholar.org/87ff/ea85fbf52e22e4808e1fcc9e40ead4ff7738.pdf<br />
# Can files locked by WannaCry be decrypted: a technical analysis. Symantec. https://medium.com/threat-intel/wannacry-ransomware-decryption-821c7e3f0a2b<br />
# Crowe J. Ransomware FAQ: how ransomware infects your computer. Barkly. https://blog.barkly.com/how-ransomware-infects-computers#infection Published Sept 2016. <br />
# How ransomware infects computers. McAfee. https://www.mcafee.com/us/security-awareness/articles/how-ransomware-infects-computers.aspx<br />
# Ransomware FAQ. Windows Defender Security Intelligence. https://www.microsoft.com/en-us/wdsi/threats/ransomware<br />
# Goodin, D. Big-name sites hit by rash of malicious ads spreading crypto ransomware. Ars Technica. Published Mar 15, 2016. https://arstechnica.com/information-technology/2016/03/big-name-sites-hit-by-rash-of-malicious-ads-spreading-crypto-ransomware/<br />
# Grobman, S. WannaCry: the old worms and the new. McAfee. https://securingtomorrow.mcafee.com/executive-perspectives/wannacry-old-worms-new/ Published May 12, 2017.<br />
# Burgess, M. Everything you need to know about EternalBlue – the NSA exploit linked to Petya. Wired. Published June 28, 2017. https://www.wired.co.uk/article/what-is-eternal-blue-exploit-vulnerability-patch<br />
# Kruse CS, Frederick B, Jacobson T, Monticone DK. 2017. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technology and Health Care 25 (2017) 1-10. <br />
# 2017 Data breach investigations report. 10th ed. Verizon. http://www.verizonenterprise.com/verizon-insights-lab/dbir/2017/<br />
# Bai G, Jiang J, Flasher R. Hospital risk of data breaches. JAMA Intern Med. 2017;177(6):878-880. doi:10.1001/jamainternmed.2017.0336<br />
# AHC Media LLC. Hackers target hospitals with “ransomware”. ED LEGAL LETT. 2016 Apr; 27(4): also available https://www.ahcmedia.com/articles/137468-hackers-target-hospitals-with-ransomware<br />
# Newman, LH. The ransomware meltdown experts warned about is here. Wired. Published May 12, 2017. https://www.wired.com/2017/05/ransomware-meltdown-experts-warned/<br />
# Cohen IG, Hoffman S, Adashi EY. Your money or your patient’s life? Ransomware and electronic health records. Ann Intern Med. 2017;167(8):587-588<br />
# Increase in ransomware and cyberattacks linked to fall in price of health data. HIPAA Journal. Dec 2016. www.hipaajournal.com/increase-in-ransomware-and-cyberattacks-linked-to-fall-in-price-of-health-data-8622.<br />
# Chinthapalli K. The hackers holding hospitals to ransom. BMJ 2017;357:j2214<br />
# 2015: the year of the healthcare data breach. HIPAA Journal. Published Dec. 29, 2015. https://www.hipaajournal.com/2015-the-year-of-the-healthcare-data-breach-8239/<br />
# Fourth annual 2017 Data Breach industry forecast. Experian. https://www.experian.com/assets/data-breach/white-papers/2017-experian-data-breach-industry-forecast.pdf<br />
# Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Published Feb 18, 2016. http://www.latimes.com/business/technology/la-me-ln-hollywood-hospital-bitcoin-20160217-story.html<br />
# Virus forces shutdown of Medstar Health System’s 10-hospital computer network. HIPAA Journal. Published Mar. 29, 2016. https://www.hipaajournal.com/virus-forces-shutdown-medstar-health-systems-10-hospital-computer-network-3372/<br />
# Monegain B. Methodist Hospital recovering from five day ransomware attack, claims it did not pay up. HealthcareITNews. Published Mar. 22, 2016. http://www.healthcareitnews.com/news/methodist-hospital-recovering-five-day-ransomware-attack-claims-it-did-not-pay<br />
# Two more Californian hospital ransomware attacks reported. HIPAA Journal. Published Mar. 23, 2016. https://www.hipaajournal.com/two-more-californian-hospital-ransomware-attacks-reported-3368/<br />
# Erlanger S, Bilefsky D, Chan S. U.K. Health Service ignored warnings for months. The New York Times. Published May 12, 2017. https://www.nytimes.com/2017/05/12/world/europe/nhs-cyberattack-warnings.html<br />
# Fox-Brewster, T. Medical devices hit by ransomware for the first time in US hospitals. Forbes. Published May 17, 2017. https://www.forbes.com/sites/thomasbrewster/2017/05/17/wannacry-ransomware-hit-real-medical-devices/#75b8806b425c<br />
# Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-91 (1996).<br />
# Department of Health and Human Services. Fact Sheet: Ransomware and HIPAA. Accessed at www.hhs.gov/sites/default/files/RansomwareFactSheet.pdf on 26 May 2017.<br />
# 45 C.F.R. § 164.302-.318 (2016).<br />
# Chen, BX. How to protect yourself from ransomware attacks. The New York Times. Published May 15, 2017. https://www.nytimes.com/2017/05/15/technology/personaltech/heres-how-to-protect-yourself-from-ransomware-attacks.html<br />
<br />
Submitted by Abigail Huang<br />
[[Category:BMI512-FALL-17]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/RansomwareRansomware2020-10-27T22:51:43Z<p>Samsun: </p>
<hr />
<div>'''Ransomware''' is a type of [[malware|malware]] (malicious software) that limits users from accessing all or part of their computer unless a ransom is paid, often in the form of cryptocurrency such as Bitcoin.<br />
Some forms of ransomware lock a computer’s screen and display a demand for payment. [1] The victim’s files remain untouched, however, and this form of ransomware can sometimes be removed without paying the attacker. [2] Newer ransomware called ''cryptoviral extortion'' encrypts a user’s files. This more advanced form of malware renders files inaccessible even if the malware is removed. [3] Thus, the victim must pay the attacker for the decryption key in order to regain access to his files. <br />
<br />
== History of encrypting ransomware ==<br />
In 1989, Joseph Popp created the first known encrypting malware called the “AIDS Trojan” which was distributed on floppy disks via snail mail. This malware was limited in its design. The AIDS Trojan only encrypted the names of files and not the files themselves. Furthermore, the trojan used symmetric encryption (where the same key is used to encrypt and decrypt files) and the decryption key could be extracted from the code of the trojan. This made it unnecessary to pay ransom to reverse the effects of the trojan. [4]<br />
<br />
The idea of using asymmetric or public key [[encryption|encryption]] was introduced by researchers Adam L. Young and Moti Yung 1996 at an IEEE symposium. [5] Actual ransomware using this scheme became increasingly common after 2005. [6] In asymmetric encryption, a different key is used for encryption (the public key) and for decryption (the private key). The public key is used to encrypt the victim’s files while the private key is known only to the creators of the ransomware. The ransomware’s effects cannot be overcome without paying for the private key. [5]<br />
<br />
== Mechanism of encryption ==<br />
More recent malware such as CryptoLocker and WannaCry use a hybrid model combining asymmetric and symmetric encryption to capitalize on the strengths of both schemes. Using asymmetric keys allows the attackers to keep the private key secret. Symmetric keys allow encryption to occur more efficiently, enabling victim files to rapidly be encrypted. [7] <br />
# The attacker creates a key pair. The public key is placed in the code of the malware. The private key is kept secret and known only to the attacker. <br />
# When the malware is run on the victim’s computer, a random symmetric key is created locally and used to encrypt all of the victim’s files. This symmetric key is then itself encrypted by the public key in the malware and generates an asymmetric ciphertext. A message is sent to the victim with the asymmetric ciphertext and information on how to pay the ransom. The victim then sends both payment and the asymmetric ciphertext to the attacker. <br />
# When the ransom is received, the attacker uses the private key to decrypt the asymmetric ciphertext to reveal the victim’s symmetric key. The symmetric key is sent to the victim.<br />
# The victim then uses the symmetric key to decrypt the files. [8]<br />
<br />
== How ransomware infects computers == <br />
* Email – Emails may contain infected attachments or links to infected websites.<br />
* Compromised Websites – Websites may have exploit kits which can infect a computer without any clicking. These websites contain malicious code that take advantage of vulnerabilities in software or browsers. If such a vulnerability exists (e.g., software patches that are not up to date), the exploit kit uses the vulnerability to download ransomware. [9] [10] [11] Even visiting reputable websites can expose a victim to exploit kits. For example, in 2016, malicious advertisements containing exploit kits affected The New York Times, the BBC, MSN, and AOL. [12]<br />
* Wormlike behavior – Certain ransomware uses a computer’s software vulnerabilities to spread throughout networks. For example, WannaCry and Petya spread via EternalBlue MS17-010. It exploited a vulnerability in Microsoft Windows operating system, specifically the network file sharing protocol Server Message Block 1.0 (SMB). This vulnerability allowed “applications on a computer to read and write to file and request services”, and the ransomware was distributed throughout local networks without any user action. Computers without the appropriate security patch were then infected and could spread the ransomware further. [13] [14] <br />
<br />
== Ransomware targets healthcare == <br />
The healthcare industry is a prime target for cyberattacks such as ransomware for many reasons. <br />
=== Ease of attack ===<br />
Hospital networks are quickly expanding to meet government requirements such as increased electronic health record information exchange. [15] However, the cybersecurity of these networks is not as robust as that of other industries like finance. The primary focus of healthcare IT systems is often patient care and rapid accessibility rather than cybersecurity [16][17]. In fact, it is estimated that less than 5% of hospital IT budgets are spent on security and there are often long delays before security patches are implemented [18] [19]. Hospitals are thus seen as “soft targets.”<br />
=== Hospitals are more likely to pay ransom ===<br />
Hospitals depend on rapid access to data in order to provide patient care. Ransomware attacks can result in compromised delivery of healthcare and lawsuits if patients suffer harm from delayed or cancelled appointments and procedures. This makes hospitals more likely to pay ransom to quickly regain access to critical and often irreplaceable data. [6] [20] <br />
=== Healthcare data is valuable ===<br />
Health data includes sensitive information such as social security numbers, insurance details, addresses, etc. Attackers can use this extensive information to perpetrate medical fraud and identity theft, access financial information, and extort money by threatening to reveal a victim’s personal history (15). The variety of possible criminal uses makes healthcare data valuable. A single patient’s health record can be sold on the black market for between $1.50 and $10. [21] This is up to ten times more valuable than a person’s credit card details. [22] <br />
However, this black market price of a single complete health record has actually fallen in 2016 due to the growing supply of breached healthcare data. (In 2015, the Department of Health and Human Services’ Office for Civil Rights estimates 113 million healthcare records were breached. [23] Before these large breaches, in 2012, a single record used to fetch $50 to $60 dollars. This fall in health record price has actually encouraged the number of ransomware attacks as cybercriminals need to steal more health records (or extort ransom) in order to achieve the same profit. [21]<br />
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<br />
The threat of ransomware to healthcare organizations is only expected to grow. The Verizon DBIR 2017 report showed that healthcare was the number two industry target for ransomware, behind Public Administration and ahead of Financial Services. In 2017, 72% of all malware incidents in the healthcare sector involved ransomware. [16] And the 2017 Experian Data Breach Industry Forecast report predicts that healthcare organizations will become the industry most heavily targeted by cybercriminals. [24] <br />
<br />
== Notable ransomware attacks on healthcare systems == <br />
<br />
* February 5, 2016 – Hollywood Presbyterian Medical Center, a 434-bed acute care hospital, experienced a Locky ransomware attack and lost access to its computer systems. This caused severe disruptions and hospital staff had to rely on pen-and-paper. The systems were restored after the Hollywood Presbyterian paid the attackers $17,000 in bitcoin ransom. [25]<br />
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* March 28, 2016 – 10 hospitals and 250 outpatient centers in the MedStar network, Washington DC were affected by ransomware, forcing a temporary shutdown of electronic health and email systems. [26]<br />
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* March 2016 – Methodist Hospital in Henderson, KY was affected by ransomware and declared an “internal state of emergency” for five days until data was restored from backups. [6] [27]<br />
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* March 18, 2016 – Chino Valley Medical Center and Desert Valley Hospital in Southern CA were attacked by ransomware. Affected computers and some hospital servers were temporarily taken offline in order to prevent further spread. Patient health records were not compromised but the attack caused significant disruption. [28]<br />
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* 2017 – UK National Health Service – The WannaCry ransomware variant affected 48 UK NHS hospital trusts. Doctor’s offices were shut down, affected hospitals diverted patients to other facilities, and non-critical appointments and surgeries were cancelled. [29]<br />
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* May 2017 – The first reports emerged of ransomware compromising medical devices in US hospitals. These attacks affected Bayer Medrad Windows-based devices [30]<br />
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<br />
== Headline text ==<br />
WannaCry: Attack on the NHS – a primary care practice perspective --[[User:Samsun|Samsun]] ([[User talk:Samsun|talk]]) 22:51, 27 October 2020 (UTC)<br />
<br />
On May 12th, 2017, global ransomware called WannaCry locked out over 230,000 computers in at least 150 countries, including the NHS in the U.K.[1]. Although the NHS was not the primary target, this cyber attack directly affected 34 percent of the hospital trusts and 8 percent of primary care practices, causing significant disruption to the services due to the cancellation of thousands of patient visits and operations. During this time, primary care practices, although not directly affected, had to shut down the computer system to prevent any further spread. So, the practices had to resort to manual processes of recording notes, reporting test results, and referrals, not to mention managing the disgruntled patients, the subsequent backlog it created, especially catching up with the sudden influx of test results and letters and the time spend input all of the handwritten notes into the Electronic Health Record (EHR). <br />
<br />
It was reported that this ransomware, which exploited a known weakness in computers running Windows, could have been prevented had security updates from Microsoft were applied promptly, a robust firewall been set up on the NHS broadband network, and legacy platforms like Windows XP were updated to newer operating systems. No ransom was reportedly paid, and the malicious software was halted in the evening of the same day when an independent cybersecurity researcher inadvertently found and activated an inbuilt “kill-switch”[2]. Although a patch was released by Microsoft the following day, some primary care practices had to wait almost seven days before it was applied to their system, causing further disruption of services.<br />
<br />
A report published by the National Audit Office[3] highlighted that though the Department of Health had a plan to deal with such a situation, this had not been tested at a local level. The NHS had also not rehearsed for such a cyberattack, which led to the initial confusion as to who would lead the response to the attack. Though the need for maintaining emergency care was identified as a priority, there was a lack of clear and timely communication with all the relevant stakeholders. It is estimated that the WannaCry ransomware attack cost the NHS £92 million, which included £20 million due to lost outputs from canceled appointment and operations, and a further £72 million to deal with the aftermath related to the recovery of the data and the restoration of the systems[4].<br />
<br />
NHS England, in its report[1], acknowledged the inadequacies within the system and highlighted plans to strengthen NHS' cyber-security, based on the key lessons that were learned from the incident. These included developing a response plan in the event of a cyberattack and establishing the resources' roles and responsibilities. It also emphasized the need to have regular monitoring of all software, ensure that they are up to date, any critical patches are applied promptly, and ensure essential and timely communication with all relevant stakeholders. Above all, it emphasized leaders, organizations, and their staff's responsibility in taking cyber threats seriously, understanding the associated risks, and proactively taking measures to mitigate these risks.<br />
<br />
NHS Digital produced a Data Security Standards guide, which layouts ten standards to mitigate the risk of a future cyberattack, addressing issues around the three main entities – people, process, and technology. The fundamentals of it being:<br />
''People: ensure staff is equipped to handle information respectfully and safely, according to the Caldicott Principles.''<br />
<br />
''Process: ensure the organization proactively prevents data security breaches and responds appropriately to incidents or near misses.''<br />
<br />
''Technology: ensure technology is secure and up-to-date.''<br />
<br />
Also, the Department of Health and Social care reported in 2018 that the NHS would spend £150 million to bolster its cybersecurity to prevent a further cyberattack like the WannaCry[5]. A subsequent report by Comparitech[6], a company that provides consumers privacy information, tools, and comparisons, underlines a relative reduction in the number of recent cyberattacks in the U.K., which according to them, could be a result of the “effective” measures implemented to thwart another cyberattack, with increased spending on measures to improve cybersecurity, practices, and training for their staff.<br />
<br />
<br />
== Impact of ransomware attacks on health systems == <br />
Ransomware attacks in healthcare systems are extremely damaging. First they endanger patient safety by preventing access to critical information in the medical record – e.g., allergies, medication lists, lab results, treatment plans, etc. Without this information, medical care can be rendered incorrectly or delayed. [20]<br />
<br />
'''Legal ramifications for hospitals'''<br />
<br />
As a result of the attack, a hospital may be subject to government action under the HIPAA Security Rule. [20] [31] A ransomware attack is considered a “security incident” defined as “attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.” Due to the increasing frequency of ransomware attacks, the U.S. Department of Health and Human Services released a fact sheet giving detailed guidance regarding ransomware and requirements such as reporting of security incidents. [32] This fact sheet clarified that a ransomware infection is considered a HIPAA breach, defined as “… the acquisition, access, use, or disclosure of PHI in a manner not permitted under the [HIPAA Privacy Rule] which comprises the security or privacy of the PHI.” [33] Specifically, ransomware encryption of protected health information is a breach since the data “was acquired (i.e., unauthorized individuals have taken possession or control of the information), and thus is a ‘disclosure’ not permitted under the HIPAA Privacy Rule.” [32]<br />
<br />
== How to prevent ransomware infections ==<br />
* Keep software updated with patches and security updates – this leaves fewer vulnerabilities for malware to exploit<br />
* Run antivirus software and keep it up-to-date <br />
* Do not click pop-up windows or links in suspicious emails. <br />
* Back up data so that if a system becomes infected, the data can be restored. <br />
* Have an organizational security plan<br />
# Set a companywide schedule for computers to get the latest software updates<br />
# Educate employees on security awareness and data hygiene [34]<br />
<br />
<br />
<br />
== References ==<br />
<br />
# Ransomware. Trend Micro. Published 2017. https://www.trendmicro.com/vinfo/us/security/definition/Ransomware.<br />
# Geier E. How to rescue your PC from ransomware. PCWorld. Published April 3, 2017. https://www.pcworld.com/article/2084002/security/how-to-rescue-your-pc-from-ransomware.html<br />
# Nagpal B, Wadhwa V. (2016) Cryptoviral Extortion: Evolution, Scenarios, and Analysis. In: Lobiyal D, Mohapatra D, Nagar A, Sahoo M. (eds) Proceedings of the International Conference on Signal, Networks, Computing, and Systems. Lecture Notes in Electrical Engineering, vol 396. Springer, New Delhi<br />
# Wilding E., Skulason F. (eds) Virus bulletin. The authoritative international publication on computer virus prevention, recognition, and removal. Published Jan 1990. https://www.virusbulletin.com/uploads/pdf/magazine/1990/199001.pdf <br />
# Young, A, Yung M. (1996). Cryptovirology: extortion-based security threats and countermeasures. IEEE Symposium on Security and Privacy. pp. 129–140. ISBN 0-8186-7417-2. doi:10.1109/SECPRI.1996.502676<br />
# Zetter Kim. Why hospitals are the perfect targets for ransomware. Wired. Published Mar. 30, 2016. https://www.wired.com/2016/03/ransomware-why-hospitals-are-the-perfect-targets/<br />
# Kappuswamy P, Al-Khalidi SQY. Hybrid encryption/decryption technique using new public key and symmetric key algorithm. MIS Review Vol. 19, No. 2, March (2014), pp. 1-13 DOI: 10.6131/MISR.2014.1902.01 https://pdfs.semanticscholar.org/87ff/ea85fbf52e22e4808e1fcc9e40ead4ff7738.pdf<br />
# Can files locked by WannaCry be decrypted: a technical analysis. Symantec. https://medium.com/threat-intel/wannacry-ransomware-decryption-821c7e3f0a2b<br />
# Crowe J. Ransomware FAQ: how ransomware infects your computer. Barkly. https://blog.barkly.com/how-ransomware-infects-computers#infection Published Sept 2016. <br />
# How ransomware infects computers. McAfee. https://www.mcafee.com/us/security-awareness/articles/how-ransomware-infects-computers.aspx<br />
# Ransomware FAQ. Windows Defender Security Intelligence. https://www.microsoft.com/en-us/wdsi/threats/ransomware<br />
# Goodin, D. Big-name sites hit by rash of malicious ads spreading crypto ransomware. Ars Technica. Published Mar 15, 2016. https://arstechnica.com/information-technology/2016/03/big-name-sites-hit-by-rash-of-malicious-ads-spreading-crypto-ransomware/<br />
# Grobman, S. WannaCry: the old worms and the new. McAfee. https://securingtomorrow.mcafee.com/executive-perspectives/wannacry-old-worms-new/ Published May 12, 2017.<br />
# Burgess, M. Everything you need to know about EternalBlue – the NSA exploit linked to Petya. Wired. Published June 28, 2017. https://www.wired.co.uk/article/what-is-eternal-blue-exploit-vulnerability-patch<br />
# Kruse CS, Frederick B, Jacobson T, Monticone DK. 2017. Cybersecurity in healthcare: a systematic review of modern threats and trends. Technology and Health Care 25 (2017) 1-10. <br />
# 2017 Data breach investigations report. 10th ed. Verizon. http://www.verizonenterprise.com/verizon-insights-lab/dbir/2017/<br />
# Bai G, Jiang J, Flasher R. Hospital risk of data breaches. JAMA Intern Med. 2017;177(6):878-880. doi:10.1001/jamainternmed.2017.0336<br />
# AHC Media LLC. Hackers target hospitals with “ransomware”. ED LEGAL LETT. 2016 Apr; 27(4): also available https://www.ahcmedia.com/articles/137468-hackers-target-hospitals-with-ransomware<br />
# Newman, LH. The ransomware meltdown experts warned about is here. Wired. Published May 12, 2017. https://www.wired.com/2017/05/ransomware-meltdown-experts-warned/<br />
# Cohen IG, Hoffman S, Adashi EY. Your money or your patient’s life? Ransomware and electronic health records. Ann Intern Med. 2017;167(8):587-588<br />
# Increase in ransomware and cyberattacks linked to fall in price of health data. HIPAA Journal. Dec 2016. www.hipaajournal.com/increase-in-ransomware-and-cyberattacks-linked-to-fall-in-price-of-health-data-8622.<br />
# Chinthapalli K. The hackers holding hospitals to ransom. BMJ 2017;357:j2214<br />
# 2015: the year of the healthcare data breach. HIPAA Journal. Published Dec. 29, 2015. https://www.hipaajournal.com/2015-the-year-of-the-healthcare-data-breach-8239/<br />
# Fourth annual 2017 Data Breach industry forecast. Experian. https://www.experian.com/assets/data-breach/white-papers/2017-experian-data-breach-industry-forecast.pdf<br />
# Winton R. Hollywood hospital pays $17,000 in bitcoin to hackers; FBI investigating. Los Angeles Times. Published Feb 18, 2016. http://www.latimes.com/business/technology/la-me-ln-hollywood-hospital-bitcoin-20160217-story.html<br />
# Virus forces shutdown of Medstar Health System’s 10-hospital computer network. HIPAA Journal. Published Mar. 29, 2016. https://www.hipaajournal.com/virus-forces-shutdown-medstar-health-systems-10-hospital-computer-network-3372/<br />
# Monegain B. Methodist Hospital recovering from five day ransomware attack, claims it did not pay up. HealthcareITNews. Published Mar. 22, 2016. http://www.healthcareitnews.com/news/methodist-hospital-recovering-five-day-ransomware-attack-claims-it-did-not-pay<br />
# Two more Californian hospital ransomware attacks reported. HIPAA Journal. Published Mar. 23, 2016. https://www.hipaajournal.com/two-more-californian-hospital-ransomware-attacks-reported-3368/<br />
# Erlanger S, Bilefsky D, Chan S. U.K. Health Service ignored warnings for months. The New York Times. Published May 12, 2017. https://www.nytimes.com/2017/05/12/world/europe/nhs-cyberattack-warnings.html<br />
# Fox-Brewster, T. Medical devices hit by ransomware for the first time in US hospitals. Forbes. Published May 17, 2017. https://www.forbes.com/sites/thomasbrewster/2017/05/17/wannacry-ransomware-hit-real-medical-devices/#75b8806b425c<br />
# Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-91 (1996).<br />
# Department of Health and Human Services. Fact Sheet: Ransomware and HIPAA. Accessed at www.hhs.gov/sites/default/files/RansomwareFactSheet.pdf on 26 May 2017.<br />
# 45 C.F.R. § 164.302-.318 (2016).<br />
# Chen, BX. How to protect yourself from ransomware attacks. The New York Times. Published May 15, 2017. https://www.nytimes.com/2017/05/15/technology/personaltech/heres-how-to-protect-yourself-from-ransomware-attacks.html<br />
<br />
Submitted by Abigail Huang<br />
[[Category:BMI512-FALL-17]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-10-27T22:33:57Z<p>Samsun: </p>
<hr />
<div><br />
== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment of 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drove global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
== Conclusion: ==<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
== References: ==<br />
<br />
[1] “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
[2] “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
[3] D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
[4] “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by Sunil Samuel<br />
[[Category:BMI512-SPRING-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-10-27T22:33:03Z<p>Samsun: </p>
<hr />
<div><br />
== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment of 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drove global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
== References: ==<br />
<br />
[1] “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
[2] “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
[3] D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
[4] “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by Sunil Samuel<br />
[[Category:BMI512-SPRING-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-10-27T22:32:45Z<p>Samsun: </p>
<hr />
<div><br />
== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment of 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drove global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
<br />
== References: ==<br />
<br />
<br />
[1] “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
[2] “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
[3] D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
[4] “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by Sunil Samuel<br />
[[Category:BMI512-SPRING-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-10-27T22:32:11Z<p>Samsun: </p>
<hr />
<div><br />
== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment of 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drove global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
<br />
== References: ==<br />
<br />
<br />
[1] “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
[2] “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
[3] D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
[4] “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by (Sunil Samuel)<br />
[[Category:BMI512-SPRING-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/5G_and_Healthcare5G and Healthcare2020-10-27T22:30:43Z<p>Samsun: Created page with " == '''5G and Healthcare''' == == Background: == Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment..."</p>
<hr />
<div><br />
== '''5G and Healthcare''' ==<br />
<br />
<br />
== Background: ==<br />
<br />
<br />
Cellular networks are entering a new digital era of connectivity. In 2019, cellular phone companies started the deployment of 5G, the fifth-generation technology standard for broadband cellular networks [1]. By using higher-frequency radio waves, a 5G network, in comparison to 3G and 4G, will have significantly increased bandwidth, and with lower latency (the response time between sending a data request to the network and receiving the data) would have the capability to deliver a more stable, reliable, faster data transmission, and significantly increased simultaneous device connectivity. The 5G Economy Study by Qualcomm reports that 5G will drove global growth. By 2035, it will help achieve $13.2 trillion in global economic output, create 23.2 million new jobs, and add $2.1 trillion in GDP growth [2]. Besides, 5G, with its higher performance and improved efficiency, is touted to deliver a better user experience and significantly impact several industries, including healthcare.<br />
<br />
Mobile and other connected devices are a standard in most healthcare organizations, but, since its inception, issues relating to connectivity has plagued healthcare wireless network infrastructure. Despite the slow pace of adoption of technological advancements in healthcare as compared to other industries, newer technologies such as artificial intelligence, big data, the Internet of Things (IoT), and wireless transmission technology is increasingly being used to meet the challenges facing healthcare and, to achieve the triple aim – improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Of particular importance is the role of mobile health and telehealth, and 5G wireless networks and other emerging technologies are becoming vital tools that will empower patients and enable clinicians, to achieve better health outcomes.<br />
<br />
<br />
== Benefits of 5G in healthcare: ==<br />
<br />
<br />
A 5G network will enable a speedy and reliable transfer of large data files of images from MRI and PET scans, thus reducing waiting times for patients and allowing clinicians to work more efficiently. High-quality video and the added functionality of virtual reality (VR) and augmented reality (AR), with its ability to simultaneously connect a large number of medical devices, will enable organizations to streamline the process of telemedicine, teleconsultation, and remote surgery [3]. AT&T is already collaborating with VITAS Healthcare in using 5G-enabled AR and VR technology to reduce pain and anxiety for terminally ill patients in a hospice by providing calming, distracting content. Remote monitoring of health will become faster and more accurate, with real-time data availability, which will also improve the delivery of personalized preventive care [4]. 5G-incorporated wearables would also facilitate in recognizing trends early and identifying medical conditions more precisely.<br />
<br />
<br />
== Challenges of implementing 5G in healthcare: ==<br />
<br />
<br />
Among the anticipated pitfalls with 5G, the main ones relate to its costs (associated with the rollout, infrastructure changes, and maintenance), its relatively smaller range (necessitating the need for a large number of antennas), coverage in rural areas, and also the concern from a proportion of the population regarding the health risks from 5G technology despite FDA's report to the contrary. Security experts are also wary of the increased data security risks associated with 5G technology. The anticipated challenges of mitigating the risks related to medical identity theft, health privacy invasion, and medical data management would be much more significant [4].<br />
<br />
Integrating 5G network technology into healthcare is much-hyped to increase patient access, improve outcomes, and enhance the efficiency of the delivery of care, and this has only grown since the start of the COVID-19 pandemic, especially with the surge in remote working and virtual visits. Though it will be several years before 5G networks become fully deployed, healthcare organizations would benefit by starting, if not already, to develop strategies about integrating 5G technology, with cautious optimism.<br />
<br />
<br />
== References: ==<br />
<br />
<br />
[1] “5G,” Wikipedia. Oct. 27, 2020, Accessed: Oct. 27, 2020. [Online]. Available: https://en.wikipedia.org/w/index.php?title=5G&oldid=985658643.<br />
[2] “What is 5G | Everything You Need to Know About 5G | 5G FAQ,” Qualcomm, Jul. 25, 2017. https://www.qualcomm.com/invention/5g/what-is-5g (accessed Oct. 27, 2020).<br />
[3] D. Li, “5G and intelligence medicine—how the next generation of wireless technology will reconstruct healthcare?,” Precis. Clin. Med., vol. 2, no. 4, pp. 205–208, Dec. 2019, doi: 10.1093/pcmedi/pbz020.<br />
[4] “5G in Healthcare: 7 Advantages & Disadvantages for Providers to Know.” https://hitconsultant.net/2019/07/18/5g-in-healthcare-7-advantages-disadvantages-for-providers-to-know/#.X5h_LS9h1TY (accessed Oct. 27, 2020).<br />
<br />
Submitted by (Sunil Samuel)<br />
[[Category:BMI512-SPRING-20]]</div>Samsunhttps://clinfowiki.org/wiki/index.php/User:SamsunUser:Samsun2020-10-22T16:48:37Z<p>Samsun: </p>
<hr />
<div>Sunil Samuel is a postdoctoral fellow in Health & Clinical Informatics at the Department of Medical Informatics & Clinical Epidemiology, OHSU. He obtained his medical degree from Kasturba Medical College, Manipal, India. After moving to the UK, he completed his post-graduate specialist training in Family Medicine in 2008. Following this, he worked as a Primary Care Physician and a managing partner at a primary care practice in the north-east of England, providing value-based population health to the 7500+ patients registered at their practice. <br />
<br />
He moved to Portland, Oregon, in early 2019, though he continued to work as a part-time PCP in the UK until the start of the COVID-19 pandemic. In June 2020, he graduated from OHSU, with an MBA in Healthcare Management.</div>Samsun